七氟醚预处理对先天性心脏病合并肺动脉高压患者围术期血清GDF-15、TNF-α、cTnI表达的影响

发布时间：2018-01-22 05:59

本文关键词： 先天性心脏病七氟醚 GDF- TNF-α cTnI　出处：《实用医学杂志》2017年18期 　论文类型：期刊论文

【摘要】：目的观察七氟醚预处理对先天性心脏病(CHD)合并肺动脉高压(PAH)患者围术期血清生长分化因子-15(GDF-15)、肿瘤坏死因子-α(TNF-α)、心有肌钙蛋白I(cTnI)表达的影响,探讨其心肌保护作用的机制。方法选取体外循环下行心内直视手术的CHD合并PAH成人患者40例,随机分为七氟醚预处理组(S组)和对照组(C组),每组20例。S组手术开始至主动脉阻断前吸入1MAC的七氟醚20min,随后予以10 min洗脱期,C组只吸入纯氧。分别于麻醉诱导前(T_0)、主动脉开放后2 h(T_1)、12 h(T_2)和24 h(T_3)、术后7 d(T_4)采集桡动脉血,测定GDF-15、TNF-α、cTnI浓度。记录心脏自动复跳率、再灌注心律失常评分、术前及术后肺动脉收缩压(PASP)。结果与术前比较,两组术后7 d PASP均降低(P0.05);与C组比较,S组心脏自动复跳率升高、再灌注心律失常评分降低(P0.05);与C组比较,S组T_1~3时GDF-15浓度均升高,TNF-α、cTnI浓度均降低(P0.05);与T_0时比较,两组T_1~3时GDF-15、TNF-α、cTnI浓度均升高,两组T_4时GDF-15浓度均降低(P0.05)。结论七氟醚预处理可能通过促进GDF-15的表达,抑制TNF-α的表达减轻CHD合并PAH患者围术期炎性反应,改善心肌缺血再灌注损伤。
[Abstract]:Objective to observe the effect of sevoflurane preconditioning on serum growth factor-15 (GDF-15) in patients with congenital heart disease (CHD) complicated with pulmonary hypertension (PAH). TNF- 伪 and TNF- 伪, the expression of cardiac troponin I ~ (2 +) was observed. Methods Forty adult patients with CHD combined with PAH undergoing open heart surgery under cardiopulmonary bypass were randomly divided into sevoflurane preconditioning group (group S) and control group (group C). Each group (n = 20) received a dose of 1 MAC sevoflurane for 20 minutes before aortic occlusion, and then 10 min elution period. In group C, pure oxygen was inhaled only. Before anesthesia induction, T _ 0 / T _ 0, 2 h after aortic opening, 12 h ~ (-1) T _ (th) and 24 h (T _ (3)) were observed. Radial artery blood was collected 7 days after operation. The concentration of GDF-15 TNF- 伪 TNF- 伪 cTnI was measured. The rate of cardiac rebeat and reperfusion arrhythmia score were recorded. Results compared with preoperative and postoperative pulmonary artery systolic blood pressure (PASP), the PASP of the two groups decreased at 7 days after operation (P 0.05). Compared with group C, the heart rate of group S increased, and the score of reperfusion arrhythmia decreased (P 0.05). Compared with group C, the concentration of GDF-15 in group S increased from 1 to 3:00, and the concentration of TNF- 伪 -cTnI decreased significantly (P 0.05). Compared with T0, the concentration of TDF-15 TNF- 伪 TNF- 伪 TnI increased in both groups. The concentration of GDF-15 decreased in both groups at T _ 4. Conclusion the preconditioning of sevoflurane may promote the expression of GDF-15. Inhibition of TNF- 伪 expression alleviated perioperative inflammatory response and improved myocardial ischemia-reperfusion injury in CHD patients with PAH.
【作者单位】：安徽医科大学附属省立医院麻醉科;
【基金】：安徽省科技厅公益性技术应用研究联动计划项目(编号:1501ld04031)
【分类号】：R614
【正文快照】： 先天性心脏病(CHD)合并肺动脉高压(PAH)的成人患者是一组特殊群体,病史长,肺血管病变严重[1],早期诊断、早期治疗有利于改善生存质量。体外循环心内直视手术等临床操作会不同程度的导致心肌缺血-再灌注损伤(myocaridal isch-emial/reperfusion injury,MIRI)。生长分化因子-15(

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