缺血预处理与温-冷-温技术在冠状动脉旁路移植术中对心肌的保护作用

目的通过监测血浆肌酸激酶同工酶(CK-MB)、心肌肌钙蛋白I(cTnI) 的水平,评价三种不同的心肌保护方法在冠状动脉旁路移植术(CABG)中的应用. 方法将36例均为稳定型心绞痛、3支血管病变、首次施行CABG患者随机分成3组缺血预处理组、温血组、对照组, 观察临床结果和术后应用血管活性药情况,并于转流前、术毕、术后6～12 、24 、72小时和第6天分别抽静脉血测定 CK-MB、cTnI. 结果缺血预处理组和温血组的自动复跳率均为100%,明显高于对照组(58%); cTnI 和CK-MB的水平从术后6～12小时开始升高(P<0.05),在24小时达到峰值,在术后第6天恢复.与对照组比较缺血预处理组和温血组在术后6～12、24、72小时时cTnI 和CK-MB的水平明显低(P<0.01). 结论多次短时间的缺血预处理和"温-冷-温"技术在低危CABG患者中较常规方法更有利于对缺血心肌的保护.

Compare the effect myocardial protection of ischemic preconditioning with warm-cool-warm cardioplegia in coronary artery bypass grafting

Objective To evaluate the effects of three different methods of myocardial protection in the patients undergoing coronary artery bypass grafting(CABG) . Methods Thirty-six patients with three vessel coronary artery disease and stable angina received for first time elective CABG were randomly divided into three groups, ischemic preconditioning group(IPC group,n=12), warm blood group(n=12),and control group(n=12). Clinical outcomes was observed during and after operation .Venous blood samples were taken in pre-bypass and after operation 6-12,24, 72 h, and 6th day measure creatine kinase(CK-MB) and cardiac troponin I(cTnI). Results The percentage of myocardial auto-resusciation in IPC group (100%) and warm blood group (100%) were significantly higher than that in the control group(58%) .The level of cTnI and CK-MB increased from postoperative 6-12 h ( P<0.05), reached peak in 24 h and recovered postoperative 6 th day.Compared with control group,cTnI and CK-MB in IPC group and warm blood group were significantly lower at 6-12, 24 and 72 h (P<0.01). Conclusion The methods of ischemic preconditioning and warm-cool-warm is safe during heart surgery and has a good protection on open heart surgery in CABG.