【摘要】 目的研究心脏停搏液氧预处理对体外循环(CPB)下二尖瓣人工机械瓣膜置换术(MVR术)患者的心肌缺血再灌注损伤保护作用。方法以风湿性心脏瓣膜病二尖瓣人工机械瓣膜置换术患者60例,采用随机数字表法分为3组(每组20例):冷血停搏液灌注组(A组);氧预处理冷晶体停搏液组(B组);冷晶体停搏液组(C组)。分别检测麻醉诱导后切皮前(T0)、术毕(T1)、术后6 h(T2)、术后24 h(T3)检测肌酸激酶同工酶(CK-MB)、心肌肌钙蛋白I(cTnI)、丙二醛(MDA)、超氧化物歧化酶(SOD)、白细胞介素(IL)-6、IL-10的变化。同时记录体外循环时间、阻断主动脉时间、心脏自动复跳以及多巴胺使用剂量等。结果 (1)3组患者体外循环时间、阻断主动脉时间、自动复跳率、多巴胺使用情况差异均无统计学意义(P>0.05);(2)心肌损伤指标的变化:T1～3时点A组、B组均低于C组(P<0.05),A组、B组差异无统计学意义(P>0.05);(3)氧化与抗氧化指标的变化:T1～3各时点A组、B组MDA均低于C组(P<0.05),A组、B组间各时点差异无统计学意义(P>0.05);A组、B组SOD浓度在T1～3时点高于C组(P>0.05),A组、B组间差异无统计学意义(P>0.05);(4)炎症与抗炎指标的变化:T1～3各时点A组、B组IL-6浓度低于C组(P<0.05),B组低于A组差异有统计学意义(P<0.05);T1～3时点A组、B组IL-10高于C组(P<0.05),B组高于A组差异有统计学意义(P<0.05)。结论 A组和B组均能较好保护心肌,抑制氧自由基活性和炎症反应,认为充氧冷晶体停搏液对心肌的保护效果与冷血停搏液大致相同,但在对炎症反应的影响上优于含血组。2组均优于冷晶体停搏液灌注技术。更多还原

【Abstract】 Objective To investigate the protective effect of oxygen precondition in cardioplegic solution on myocardial ischemia reperfusion injury in patients undergoing mechanical prosthetic valve replacement(MVR) under cardiopulmonary bypass(CPB). Methods Sixty patients with rheumatic heart disease treated with mitral valve replacement were randomly divided into three groups: cold blood cardioplegia intermittent perfusion(group A);oxygen pretreatment cold crystalloid cardioplegia(group B); cold crystalloid cardioplegia(group C). We respectively detected the change of venous blood creatine kinase(CK-MB), cardiac troponin I(cTnI), malondialdehyde(MDA), superoxide dismutase(SOD), and interleukin-6(IL)-6, IL-10, after induction of anesthesia(T0), end of operation(T1), 6 h after operation(T2), 24 h after operation(T3) a total of 4 time points. We simultaneously recorded the time of cardiopul-monary bypass, the time of interruption, the automatic cardiac beating and the dosage of dopamine. Results(1)There were no statistically significant differences in extracorporeal circulation time, aortic cross-clamp time, auto-rebeat rate of heart and dopamine dose among the three groups(P>0.05).(2)The biomarkers of myocardial injury : At t1-3, both group A and group B were lower than group C(P<0.05), and there was no statistical difference between group A and group B(P>0.05).(3)oxidation and antioxidantion :At each time point of T1-3, the MDA concentrations in group A and group B were lower than those in group C(P<0.05). There′s no statistical difference between group A and group B(P>0.05).(4)Inflammation and anti-inflammatory indicators: IL-6 concentration in group A and group B was lower than that in group C(P<0.05), and that in group B was lower than that in group A(P<0.05), the difference was statistically significant. IL-10 concentration in group A and group B was higher than that in group C(P<0.05), and that in group B was higher than that in group A(P<0.05), the difference was statistically significant too. Conclusion Both group A and group B can lower oxygen free radical activity and inflammatory response, implying better myocardial protection,The effect of pre-oxygenating cold crystalloid cardioplegia perfusion on myocardial protection was approxi-mately the same as cold blood cardioplegia perfusion, but it’s better than cold blood cardioplegia perfusion on in-flammatory response. Both cold blood cardioplegia perfusion and pre-oxygenating cold crystalloid cardioplegia perfu-sion were superior to the cold crystalloid cardioplegia perfusion on myocardial protection.更多还原