改良心肌保护液在瓣膜病患者置换手术中心肌保护作用的临床观察

目的:探讨改良心肌保护液在重症心脏瓣膜病置换手术中对心脏、肝脏及肾脏的保护作用。方法:90例首次重症心脏瓣膜病置换术者随机分为三组,分别为实验组(改良心肌保护液添加腺苷A组)、实验组(改良心肌保护液添加腺苷和丹参B组)和对照组(C组),各30例。三组患者分别于麻醉诱导前、体外循环(CPB)开始后30 min、CPB结束30 min及术后24 h采集血标本,行肌酸激酶同工酶(CK-MB)、乳酸脱氢酶(LDH)、心肌肌钙蛋白(cTnI)、谷丙转氨酶(ALT)、谷草转氨酶(AST)、血尿素氮(BUN)及Cr,并检测血浆肿瘤坏死因子-α(TNF-α),白细胞介素-6(IL-6),白细胞介素-8(IL-8)和白细胞介素-10(IL-10)血浆水平变化,探讨改良心肌保护液在心内直视手术中心脏、肝脏及肾脏的保护效果。结果:实验组(A组)、实验组(B组)和对照组(C组),ALT、AST、BUN、CR及CK-MB均有升高,但是对照组升高显著,A组和B组比较差异有统计学意义(P0.05),A组、B组和对照组(C组)比较差异有统计学意义(P0.01),TNF-α、IL-6及IL-8水平均比术前的明显升高(P0.05),开放升主动脉后1 h达高峰,之后逐渐下降。对照组TNF-α、IL-6、IL-8明显高于诱导前以及相同时点治疗组的水平(P0.01);CPB结束后30 min及24 h,三组IL-10水平均明显增高,但治疗组明显高于对照组(P0.01).结论:改良心肌保护液对成熟心肌有良好的保护作用,应用能明显降低重症心脏瓣膜病置换术患者血浆TNF-α、IL-6及IL-8水平,同时可促进抑制炎细胞因子(IL-10)的分泌,从而有效降低由CPB引发的炎症反应,促进器官功能的恢复,对心、肺、肝及肾脏等重要脏器有保护作用。

Improvement of myocardial protection liquid in valve disease replacement surgery in clinical observation of the myocardial protection

Objective：To study the myocardial protection fluid in serious heart valve replacement operation of the heart,liver,kidney of protection.Methods：90 cases of heart valve replacement of the first time were randomly divided into three groups.The experimental group （improved myocardial protection fluid add adenosine group A）,the experimental group （improved myocardial protection fluid add adenosine and salvia miltiorrhiza group B） and the control group （group C）,30 cases in each group.The blood samples were taked from the center vein at the time before anaesthetize inducement,at the time of 30 minutes after cardio pulmonary bypass （CPB）,at the time of 1 hour after the aortic open,at the time of 30 minutes after CPB end and at the time of 24 hours postoperation,The serum levels of the ALT,BUN,CR,AST,CK-MB and blood plasma tumor necrosis factor （TNF-α）,interleuk6 （IL-6）,i nterleuk 8 （IL-8）,interleuk 10 （IL-10） were detected respectively.This paper discusses improvement myocardial protection liquid-liquid in heart surgery to look straight into the heart,liver,kidney protective effect.Results：The （group A） and the experimental group （group B） and the control group （group C） after surgical operation,all serum levels of the ALT,BUN,CR,AST,CK-MB increased,but the control group increased significantly,A group and B group have remarkable difference（P ＜0.05）,A group and B group had remarkable difference in comparison with that control group （P ＜0.01）,all serum levels of TNF-a,IL-6,IL-8 obviously improved before comparing surgical operation （P ＜ 0.05）,1 hour after the asending aorta open reach high peak,then gradually descended.The control group serum levels of TNF-α,IL-6,IL-8 increased significantly at the time of before inducement and homology order the serum levels of treatment groups （P ＜0.01）,30 minutes after CPB end and 24 hours.Three groups of serum levels of IL-10 increased,but the treatment groups increased significantly in comparison with that control group （P ＜ 0.01）.Conclusion：The use of improvement myocardial protection fluid to mature myocardial good protection effect,can reduce the myocardial cells and interstitial edema,,mitochondrial damage light,application can obviously decline the serum levels of TNF-α,IL-6,IL-8 in the serious heart valvc replacement patient,and can promote the secret inhibitive of inflammation IL-10,so that can relieve inflammatory response induced by CPB,and promote the recovery of organ function,and exert to protection of important organ of the heart,lung,liver,kidney function and other vital organs have protection.