尼可地尔对心脏瓣膜置换术患者心肌缺血再灌注损伤的保护作用

目的：观察尼可地尔对心脏瓣膜置换术患者心肌缺血再灌损伤的保护作用。方法：60例心脏瓣膜置换术患者分为对照组（Ⅰ组）、尼可地尔延迟处理组（Ⅱ组）、尼可地尔早期处理组（Ⅲ组），每组20例。Ⅱ组在术前24h用尼可地尔20mg静滴。Ⅲ组在麻醉诱导后用尼可地尔20mg静滴。在阻断主动脉即刻（T0）、开放主动脉15min（T1）、30min（T2）、60min（T3）、90min（T4）取冠状静脉窦血测定心肌肌钙蛋白（cTnI）、TNF-α、IL-6，并记录心脏复跳方式和心脏复跳后的心律失常发生率。在阻断主动脉即刻和开放主动脉后30min取右房肌肉组织行电镜观察。结果：Ⅱ、Ⅲ组cTnI、TNF—α、IL-6含量明显低于Ⅰ组，电镜下心肌超微结构受损程度小于Ⅰ组。Ⅱ组患者在T3、T4时刻与Ⅲ组患者同时值比较：cTnI、TNF—α、IL-6含量降低，心肌超微结构受损程度小于Ⅲ组。结论：尼可地尔可明显减轻心脏瓣膜置换术患者心肌缺血再灌注损伤，延迟处理方式的保护作用优于早期处理方式。

Protective effect of nicorandil on myocardial ischemia reperfusion injury in patients undergoing cardiac valve replacement

AIM： To observe the protective effect of nicorandil on myocardial isehemia reperfusion injury in patients undergoing valve replacement. METHODS： Sixty patients undergoing valve repalacement were randomly divided into 3 groups： control（ I ） group, nicorandil delayed precondictioning（ II ） group and nicorandil preconditioning （ III ） group. 20 mg nicorandil was given i. v. 24 h before operation in group II , whereas in group III , 20 mg nicorandil was given i. v. after induction of anesthesia. Blood samples were taken from coronary venous for de termination of cTnI, TNF-α, IL-6 levels at aor tic clamping （T0）, 15 min （T1）, 30 rain（T2）, 60 rain （T3）, 90 min（T4） after aortic deelamping. Right atria myocardium tissue were taken at To and T2 to observe the histopathological changes with electron microscopy. RESULTS： The levels of eTnI, TNF-α and IL-6 in group II and III were significantly lower than those in group I. Myocardium injury was obviously lighter in group II and III than that in group I , whereas the levels of cTnI, TNF-α, IL-6 and myocardium injury were lower in group II than those in group III. CONCLUSION： Nicorandil is effcetive in decreasing myocardial ischemia repefusion injury in patients undergoing valve replacement, The protective effect of nicorandil delayed preconditioning is more obvious than precondictioning.