【摘要】 目的探讨风湿性心脏病心脏瓣膜置换术患者,经冠状静脉窦逆行灌注方法对血清基质金属蛋白酶9(MMP-9)、基质金属蛋白酶3(MMP-3)和心肌肌钙蛋白I(cTnI)的影响。方法56例风湿性心脏病行体外循环(CPB)下心脏瓣膜置换术患者随机分为主动脉根部顺行灌注心肌停跳液(AC)组和持续冠状静脉窦逆行灌注心肌停跳液(RC)组,每组28例。于6个时点采静脉血,检测MMP-9、MMP-3和cTnI水平。结果CPB开始后,两组患者MMP-9、MMP-3和cTnI水平均升高,MMP-9术后即刻达峰值,MMP-3和cTnI术后8h达到峰值,但RC组峰值均低于AC组[MMP-9为(203.3±30.2)ng/ml比(427.3±46.7)ng/ml,MMP-3为(113.4±16.2)ng/ml比(257.8±19.6)ng/ml,cTnI为(10.50±2.03)ng/ml比(14.45±2.26)ng/ml],且RC组回落速度快于AC组。结论逆行灌注能有效降低基质金属蛋白酶水平,减轻炎性反应,抑制细胞外基质降解所致的心肌重构,从而起到更好的心肌保护作用。更多还原

【Abstract】 Objective To investigate the effects of retrograde cardioplegia on serum levels of matrix metalloproteinase 9(MMP-9),matrix metalloproteinase 3(MMP-3) and cardiac troponin I(cTnI) in the process of heart valve replacement operation.Methods Fifty cases of undergoing heart valve replacement with cardiopulmonary bypass (CPB) were randomly divided into antegrade cardioplegia group(AC group) and retrograde cardioplegia group(RC group) of 28 each.Serum levels of MMP-9,MMP-3 and cTnI were measured using enzymelinked immunosorbent assay (ELISA) at the six times.Results After the CPB,the levels of MMP-9,MMP-3 and cTnI ascended quickly,MMP-9 achieved the peak value at the end of CPB,MMP-3 and cTnI achieved the peak value at the time of eight hours after operation.The peak value of RV group was lower than that of AC group[MMP-9(203.3±30.2)ng/ml vs(427.3±46.7)ng/ml,MMP-3(113.4±16.2)ng/ml vs (257.8±19.6)ng/ml,cTnI(10.50±2.03)ng/ml vs (14.45±2.26)ng/ml]d the declined degree was faster than AC group.Conclusions Retroperfusion had a better myocardial protection to the patients suffering heart valve replacement operation through effectually depressed expression of matrix metalloproteinases,palliated inflammatory reaction and suppressed myocardial reconstitution.更多还原