缺血后处理对中老年患者在体外循环下心脏瓣膜置换术中心肌损伤的改善作用
【摘要】 目的：探討缺血后处理对中老年患者在体外循环下心脏瓣膜置换术中心肌损伤的改善作用。方法：将2011年9月-2016年9月本院收治的84例45岁以上（含45岁）行体外循环下心脏瓣膜置换术患者随机分为研究组与对照组，每组各42例。两组术前均给予麻醉诱导，研究组另实施缺血后处理。观察两组麻醉效果（体外循环时间、主动脉阻断时间、复跳时间）、麻醉诱导手术前（T1）、升主动脉开放后12 h（T4）心肌标志物[心肌脂肪酶结合蛋白（H-FABP）、心肌肌钙蛋白I（cTnI）]变化、心肌细胞病理学结果构成情况，同时随访1年主要心血管事件发生率。结果：研究组体外循环时间、主动脉阻断时间较对照组长，但两组比较差异均无统计学意义（P>0.05），而复跳时间明显短于对照组（P<0.05）。T1时刻两组H-FABP、cTnI比较差异均无统计学意义（P>0.05），T2时刻两组H-FABP、cTnI均较T1时刻明显升高，但对照组升高幅度较研究组明显（P<0.05）。术后研究组心肌细胞病理学损伤总发生率4.76%明显低于对照组33.33%（P<0.05）。研究组术后1年主要心血管事件发生率较对照组低，但比较差异无统计学意义（P>0.05）。结论：缺血后处理能有效减轻中老年患者体外循环下心脏瓣膜置换术中心肌损伤，对体外循环时间、主动脉阻断时间及预后效果无较大影响，可作为中老年患者体外循环下心脏瓣膜置换术中预防心肌损伤的重要措施。
【关键词】 心脏瓣膜置换术； 体外循环； 缺血后处理； 心肌损伤
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.