甘露醇预处理在体外循环手术中对心肌的保护作用

发布时间：2018-01-15 03:23

本文关键词：甘露醇预处理在体外循环手术中对心肌的保护作用　出处：《山东医药》2015年12期 　论文类型：期刊论文

【摘要】：目的观察甘露醇预处理对体外循环(CPB)手术中心肌缺血再灌注损伤(MIRI)的保护作用。方法将60例经CPB辅助灌注冷停跳液手术患者随机分为A、B组各30例,A组麻醉诱导前静注20%甘露醇1.5 m L/kg预处理,CPB结束升主动脉开放前15 min再次静注20%甘露醇1.5 m L/kg;B组常规开放主动脉,心脏复跳。记录心脏自动复跳率、术后呼吸机支持时间、主动脉开放后CPB辅助时间、手术死亡率、低心排血量发生率及肾上腺素的应用。于麻醉诱导后(T1)及开放主动脉后2(T2)、6(T3)、18 h(T4)经桡动脉采血,检测血浆心肌肌钙蛋白I(Tn I)、肌酸激酶同工酶(CK-MB)、肌酸激酶(CK)。结果 A组心脏自动复跳率87%、主动脉开放后体外循环时间(35±11)min,B组分别为60%、(42±17)min,P均0.05。与T1比较,两组各时点血浆Tn I、CK-MB、CK均升高(P0.05或0.01);与B组同时点比较,A组血浆Tn I、CK-MB、CK降低(P0.05或0.01)。结论甘露醇预处理可减轻CPB手术患者心肌MIRI,具有良好的心肌保护作用;该作用可能与其抗氧化,减轻Tn I的释放有关。
[Abstract]:Objective to observe the effect of mannitol preconditioning on myocardial ischemia-reperfusion injury during cardiopulmonary bypass (CPB) operation. Methods A total of 60 patients undergoing CPB assisted cold cardioplegia operation were randomly divided into two groups. Group B (n = 30) and group A (n = 30) were pretreated with 20% mannitol (1.5 mL / kg) intravenously before anesthesia induction. 20% mannitol (1.5 mL / kg) was intravenously injected 15 min before the opening of ascending aorta in CPB. In group B, routine open aorta and cardiac resuscitation were recorded. The rate of cardiac resuscitation, the time of postoperative ventilator support, the assistant time of CPB after aortic opening, and the operative mortality were recorded. The incidence of low cardiac output and the application of epinephrine. Blood was collected from the radial artery after anesthesia induction (T1) and the opening of aorta (T2 + T2 + 6 T3 + 18 h T4). Plasma cardiac troponin I ~ (2 +) T _ n I ~ (2 +), creatine kinase isoenzyme (CK-MBN) and creatine kinase (CK) were detected. Results the heart rate of group A was 87%. The time of cardiopulmonary bypass (CPB) after aortic opening was 35 卤11 min in group B and 60 in group B and 42 卤17 min in group B (P < 0.05). Compared with T1, the plasma TN I of group B was higher than that of group T 1 at different time points. CK-MBN CK was significantly higher than that of control group (P0.05 or 0.01). Compared with group B at the same time, plasma TNI CK-MBCK in group A decreased by P05 or 0.01.Conclusion mannitol pretreatment can alleviate myocardial MIRI in patients undergoing CPB surgery. It has good myocardial protective effect. This effect may be related to its antioxidation and reducing the release of TNI.
【作者单位】：承德市中心医院;承德市第三医院;
【分类号】：R654.1
【正文快照】： 研究表明,心肌缺血再灌注损伤(MIRI)与多种因素有关。虽然有关心肌保护方面的研究已取得一定进展,但尚不十分满意。甘露醇是一种有效的氧自由基清除剂,在防治再灌注损伤中具有重要作用。我们对心内直视手术患者仅行甘露醇预处理,观察围手术期患者血浆心肌肌钙蛋白I(Tn I)、肌

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