缺血后處理對(duì)中老年患者在體外循環(huán)下心臟瓣膜置換術(shù)中心肌損傷的改善作用

　　【摘要】 目的：探討缺血后處理對(duì)中老年患者在體外循環(huán)下心臟瓣膜置換術(shù)中心肌損傷的改善作用。方法：將2011年9月-2016年9月本院收治的84例45歲以上（含45歲）行體外循環(huán)下心臟瓣膜置換術(shù)患者隨機(jī)分為研究組與對(duì)照組，每組各42例。兩組術(shù)前均給予麻醉誘導(dǎo)，研究組另實(shí)施缺血后處理。觀察兩組麻醉效果（體外循環(huán)時(shí)間、主動(dòng)脈阻斷時(shí)間、復(fù)跳時(shí)間）、麻醉誘導(dǎo)手術(shù)前（T1）、升主動(dòng)脈開放后12 h（T4）心肌標(biāo)志物[心肌脂肪酶結(jié)合蛋白（H-FABP）、心肌肌鈣蛋白I（cTnI）]變化、心肌細(xì)胞病理學(xué)結(jié)果構(gòu)成情況，同時(shí)隨訪1年主要心血管事件發(fā)生率。結(jié)果：研究組體外循環(huán)時(shí)間、主動(dòng)脈阻斷時(shí)間較對(duì)照組長(zhǎng)，但兩組比較差異均無統(tǒng)計(jì)學(xué)意義（P>0.05），而復(fù)跳時(shí)間明顯短于對(duì)照組（P<0.05）。T1時(shí)刻兩組H-FABP、cTnI比較差異均無統(tǒng)計(jì)學(xué)意義（P>0.05），T2時(shí)刻兩組H-FABP、cTnI均較T1時(shí)刻明顯升高，但對(duì)照組升高幅度較研究組明顯（P<0.05）。術(shù)后研究組心肌細(xì)胞病理學(xué)損傷總發(fā)生率4.76%明顯低于對(duì)照組33.33%（P<0.05）。研究組術(shù)后1年主要心血管事件發(fā)生率較對(duì)照組低，但比較差異無統(tǒng)計(jì)學(xué)意義（P>0.05）。結(jié)論：缺血后處理能有效減輕中老年患者體外循環(huán)下心臟瓣膜置換術(shù)中心肌損傷，對(duì)體外循環(huán)時(shí)間、主動(dòng)脈阻斷時(shí)間及預(yù)后效果無較大影響，可作為中老年患者體外循環(huán)下心臟瓣膜置換術(shù)中預(yù)防心肌損傷的重要措施。
　　【關(guān)鍵詞】 心臟瓣膜置換術(shù)； 體外循環(huán)； 缺血后處理； 心肌損傷
　　The Relief Effect of Ischemic Postconditioning on Myocardial Injury in Middle and Aged Patients Undergoing Cardiac Valve Replacement under Cardiopulmonary Bypass/CHENG Yijian.//Medical Innovation of China，2018，15（07）：049-052
　　【Abstract】 Objective：To investigate the relief effect of ischemic postconditioning on myocardial injury in middle and aged patients undergoing cardiac valve replacement under cardiopulmonary bypass（CPB）.Method：A total of 84 patients who was elder than 45 years old（including 45 years old） undergoing cardiac valve replacement under CPB in our hospital from September 2011 to September 2016 were divided into the study group and the control group randomly，42 cases in each group.All patients were given anesthesia induction before operation，and the study group were additionally given ischemic postconditioning.The anesthetic effects（time of CPB， aortic clamping time and re-beat time），changes of myocardial markers[heart fatty acid-binding protein （H-FABP），cardiac troponin I （cTnI）]before induction of anesthesia（T1）and 12 h after opening aorta（T2），myocardial cell pathological results in two groups were observed.The incidence of major cardiovascular events in 1 year was recorded.Result：The time of CPB and aortic clamping time in the study group were longer than those in the control group（P>0.05），and the re-beat time in the study was significantly shorter than that in the control group（P<0.05）.There was no significant difference in H-FABP and cTnI between two groups at T1（P>0.05）.H-FABP and cTnI in two groups were significantly increased at T2，and the increase was more obvious in the control group than the study group（P<0.05）.After operation，the incidence of myocardial cell pathological injury was significantly lower in the study group thanthe control group（P<0.05）.The incidence of major cardiovascular events in 1 year after operation was lower than that in the control group in study group（P>0.05）.Conclusion：Ischemic postconditioning can effectively reduce myocardial cell injury in patients undergoing cardiac valve replacement under CPB，and the protective effect on myocardial function in middle and aged patients is significantly.There is little effect on time of CPB，aortic clamping time effect and prognosis.It can be used as an important prevention measure for myocardial injury in middle and aged patients undergoing cardiac valve replacement under CPB.

相關(guān)熱詞搜索：體外循環(huán) 瓣膜 缺血 心肌 損傷