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河北医学  2020, Vol. 26 Issue (4): 581-585    DOI: 10.3969/j.issn.1006-6233.2020.04.013
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远隔缺血处理对心脏瓣膜置换术患者血清心肌肌钙蛋白及全身炎性反应影响
庄焕伟1, 白树堂1, 符洪犊1, 梁丽明1, 欧阳华1, 张亮2
1. 中南大学湘雅医学院附属海口医院心胸外科, 海南 海口 570208;
2. 中山大学附属第七医院(深圳)胸外科, 广东 深圳 518107
Effects of Remote Ischemia on Serum Cardiac Troponin and Systemic Inflammatory Response in Patients Undergoing Cardiac Valve Replacement
ZHUANG Huanwei, BAI Shutang, FU Hongdu, et al
Haikou Hospital Affiliated to Xiangya Medical College, Hainan Haikou 570208, China
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摘要 目的:探究远隔缺血处理(RIPC)对心脏瓣膜置换术患者血清心肌肌钙蛋白I(cTnI)及全身炎性反应影响。方法:选取2017年8月至2019年8月于本院进行心脏瓣膜置换术的患者66例为研究对象,按随机数字表法分为研究组和对照组,每组各33例。其中研究组患者在麻醉诱导后采用RIPC,对照组行常规止血带处理。比较两组不同处理方式对患者CTnI及炎性因子(TNF-α、IL-6、IL-8)的影响。结果:两组患者主动脉开放后cTnI浓度随时间的变化逐渐递增(P<0.05),研究组cTnI浓度低于对照组(P<0.05)。同时,两组患者在麻醉诱导前至主动脉开放6h的BNP水平逐渐降低(P<0.05),主动脉开放24h后迅速升高(P<0.05),但研究组在主动脉开放30min、6h、24h的BNP水平低于对照组(P<0.05)。另外两组患者术后1d的TNF-α、IL-6、IL-8水平均升高(P<0.05),但术后3d、术后7d的TNF-α、IL-6、IL-8水平均呈下降趋势(P<0.05),且研究组患者的TNF-α、IL-6、IL-8水平在术后3d、7d均低于对照组(P<0.05)。结论:远隔缺血时处理可有效减轻心肌的缺血再灌注损伤,在瓣膜置换手术中对心肌起到了保护作用,且对于患者炎症反应的降低具有积极意义。
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关键词 远隔缺血处理心脏瓣膜置换术心肌肌钙蛋白炎性反应    
AbstractObjective: To investigate the effects of remote ischemic treatment (RIPC) on serum cardiac troponin I (cTnI) and systemic inflammatory response in patients undergoing cardiac valve replacement. Methods: A total of 66 patients who underwent cardiac valve replacement in our hospital from August 2017 to August 2019 were selected as the study subjects. They were divided into study group and control group according to the random number table method, with 33 cases in each group. Patients in the study group were treated with RIPC after anesthesia induction, and patients in the control group were treated with conventional tourniquet. The effects of different treatments on CTnI and inflammatory factors (TNF-α,IL-6,IL-8) were compared between the two groups. Results: CTnI concentration in the two groups increased gradually with time after aortic dissection (P<0.05), and the concentration of cTnI in the study group was lower than that in the control group (P<0.05).At the same time, the BNP level of the patients in the two groups was gradually decreased (P<0.05) until 6h before anesthesia induction, and increased rapidly after 24h of aorta opening (P<0.05). However, the BNP level in the study group was lower than that in the control group (P<0.05) after 30min, 6h and 24h of aorta opening. In the other two groups.the levels of TNF-α,IL-6,IL-8 increased at one day after opereation (P<0.05), but the levels of TNF-α,IL-6,IL-8 at 3 and 7 days after operation were showed a dounwardtreat (P<0.05). and the level of TNF-α,IL-6,IL-8 in paeitns in this study group were louer than those inthe control group at 3 and 7 days after surgery (P<0.05).Conclusion: The treatment of distant ischemia can effectively reduce the myocardial ischemia-reperfusion injury, play a protective role in valve replacement surgery, and has a positive significance for the reduction of inflammatory response in patients.
Key wordsRemote ischemic treatment    Heart valve replacement    Cardiac troponin    Inflammatory reaction
    
基金资助:海南省医药卫生科研项目,(编号:1601320273A2002)
引用本文:   
庄焕伟, 白树堂, 符洪犊, 梁丽明, 欧阳华, 张亮. 远隔缺血处理对心脏瓣膜置换术患者血清心肌肌钙蛋白及全身炎性反应影响[J]. 河北医学, 2020, 26(4): 581-585.
ZHUANG Huanwei, BAI Shutang, FU Hongdu, et al. Effects of Remote Ischemia on Serum Cardiac Troponin and Systemic Inflammatory Response in Patients Undergoing Cardiac Valve Replacement. HeBei Med, 2020, 26(4): 581-585.
链接本文:  
http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2020.04.013     或     http://www.hbyxzzs.cn/CN/Y2020/V26/I4/581
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