无创性肢体缺血后处理在小儿法乐四联症根治术中的心肌保护作用

发布时间：2018-05-11 02:23

  本文选题：无创性缺血后处理 + 下肢缺血后处理　； 参考：《新乡医学院》2012年硕士论文

【摘要】：目的缺血后处理作为一种内源性心肌保护方式,能够明显减轻心肌的缺血-再灌注损伤,改善心肌功能,是缺血预处理的发展。而远距离缺血后处理作为经典缺血后处理的发展,具有可预知性及易操控性,在心肌缺血-再灌损伤中的保护作用得到大量动物实验证实,其中无创性肢体缺血后处理以其无创、简便的优点,近年来在动物实验中研究较多,但临床报道较少。本实验从临床不同角度研究远距离无创性肢体缺血后处理对小儿法乐四联症体外循环根治术中心肌缺血-再灌注损伤的保护作用,为临床应用提供理论依据。 资料和方法本实验选择2010年10月至2011年12月中国武警总医院心血管外科收治的法乐四联症根治手术患儿50例,年龄范围6月-7岁。患儿随机分为两组：实验组(下肢缺血后处理组,n=25)和对照组(n=25)。实验组于左下肢距膝关节上方1-2cm处绑缚气压袖带,在阻断主动脉的同时给予充气加压,压力维持根据患儿具体年龄及体重情况波动在150-200mmHg,以足背动脉搏动消失、经皮末梢氧饱和度监测呈直线为准,持续3分钟后松开气囊,3分钟后再次加压,循环3个周期。对照组常规体外循环手术,不进行肢体缺血操作。分别记录两组主动脉阻断时间、体外循环转流时间、心脏自动复跳比率,复跳后心律失常发生率和术后24小时内正性肌力药物计分、呼吸机辅助时间、渗漏综合征及低心排出量综合征发生率；两组分别于术前、主动脉开放后1小时、6小时、24小时抽取静脉血测定血清肌酸激酶同工酶、肌红蛋白及肌钙蛋白Ⅰ。 结果两组患儿术前各项指标包括性别、年龄、体重、血红蛋白、末梢氧饱和度、McGoon指数、左室舒张末容积指数、肌红蛋白、肌酸激酶同工酶、肌钙蛋白Ⅰ以及术中主动脉阻断时间、体外循环转流时间均无统计学上的差异性(P0.05)。实验组患儿的心脏自动复跳率较对照组有所增高,术后呼吸机辅助时间、渗漏综合征及低心排出量综合征的发生率均较对照组低,但均无明显差异(P0.05)；复跳后心律失常发生率和正性肌力药物计分较对照组降低,具有统计学差异(P0.05)。主动脉开放后1小时后两组间的肌酸激酶同工酶、肌红蛋白和肌钙蛋白Ⅰ均无统计学筹异(P0.05),两组的肌红蛋白较术前均明显增高(P0.05)；在主动脉开放后6小时、24小时两组的肌酸激酶同工酶、肌红蛋白和肌钙蛋白Ⅰ较术前均有明显升高,且实验组的肌酸激酶同工酶、肌红蛋白和肌钙蛋白Ⅰ均较对照组降低(P0.05),开放6小时时两组间肌酸激酶同工酶、肌红蛋白和肌钙蛋白Ⅰ均有统计学差异(P0.05),开放后24小时时两组间肌钙蛋白Ⅰ有统计学差异(P0.05)。 结论无创性下肢缺血后处理组可以明显减少复跳后心律失常发生率及正性肌力药物用量；无创性下肢缺血后处理可以减轻小儿法乐四联症根治术体外循环中的缺血.-再灌注损伤,对心肌具有一定的保护作用。
[Abstract]:Objective as an endogenous myocardial protection method, ischemic post-treatment can significantly reduce myocardial ischemia-reperfusion injury and improve myocardial function, which is the development of ischemic preconditioning. However, as the development of classical ischemic postprocessing, the long distance ischemic postprocessing has the characteristics of predictability and maneuverability. The protective effect in myocardial ischemia reperfusion injury has been confirmed by a large number of animal experiments. Among them, noninvasive post-treatment of limb ischemia, with its advantages of non-invasive and simple, has been studied in animal experiments in recent years, but there are few clinical reports. The purpose of this study was to study the protective effect of long distance noninvasive limb ischemia post-treatment on myocardial ischemia-reperfusion injury in children with tetralogy of Fallot during cardiopulmonary bypass (CPB) from different clinical angles, and to provide theoretical basis for clinical application. Materials and methods 50 children with tetralogy of Fallot, aged from 6 to 7 years old, were selected from October 2010 to December 2011 in Cardiovascular surgery, China Armed Police General Hospital. The children were randomly divided into two groups: experimental group (post-ischemic treatment group) and control group. In the experimental group, the pressure cuff was tied to the upper 1-2cm of the knee joint in the left lower extremity, and the aortic artery was blocked with inflatable pressure. The pressure maintained fluctuated from 150 to 200 mm Hg according to the specific age and weight of the child, and disappeared as the pulsatile of the dorsal foot artery. The oxygen saturation at the end of the skin was monitored in a straight line. After 3 minutes, the oxygen saturation was released and then pressurized again after 3 minutes, followed by 3 cycles of circulation. In the control group, the routine cardiopulmonary bypass operation was not performed. The aortic occlusion time, cardiopulmonary bypass (CPB) rate, the incidence of arrhythmia after cardiopulmonary bypass (CPB), the incidence of cardiac arrhythmias, the score of positive muscle strength drugs within 24 hours after cardiopulmonary bypass, and the time of ventilator were recorded The incidences of leakage syndrome and low cardiac output syndrome were measured before operation and 6 hours after aortic opening and 24 hours after aortic opening. Serum creatine kinase isoenzyme, myoglobin and troponin 鈪，

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