远端缺血预处理对瓣膜置换患者急性心肌损伤的影响

发布时间：2018-03-06 22:28

本文选题：远端缺血预处理　切入点：心肌保护　出处：《安徽医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的研究远端缺血预处理(remote ischemic preconditioning,RIPC)对成年非重症瓣膜置换患者围手术期急性心肌损伤和临床预后的影响。方法80名非重症具有瓣膜置换指征成年住院患者被随机分配到远端缺血预处理治疗组(RIPC GROUP)和对照组(CONTROL GROUP)。RIPC组患者于麻醉后开胸前于在右下肢行3周期缺血预处理,每周期加压止血带充气至200mm Hg,维持5分钟,再放气5分钟。测定预处理前、预处理后,主动脉开放后4、24、48小时各时间点血浆肌酸激酶同工酶(MB isoenzyme of Creatine Kinase,CK-MB)和肌钙蛋白I(Cardiac Troponin,Ic Tn I)值,同时记录术前、术中、术后的各时点血液动力学数值,阻断时间、体外循环时间,心脏自动复跳率,术前及术后左室射血分数,术前及术后24、48小时肌酐值,术后机械通气时间、术后新发房颤率、ICU停留时间以及术后住院时间。结果两组间患者术前、术中和术后的血流动力学数值组无明显差异(P0.05),两组患者术后机械通气时间、ICU停留时间、术后住院时间,急性肾损害发生率、新发房颤率也无明显差异(P0.05)。但RIPC组CK-MB值和c Tn I值的水平在主动脉开放后4小时、24小时及48小时显著低于对照组(P0.05)。结论本研究表明,远程缺血预处理可能降低接受瓣膜置换的患者CK-MB和c Tn I的释放水平。然而,RIPC并没有改善这些患者的短期临床预后。
[Abstract]:Objective to study the effect of remote ischemic preconditioning (RIPC) on perioperative acute myocardial injury and clinical prognosis in adult non-severe valve replacement patients. Methods 80 non-severe adult inpatients with valvular replacement indication were randomly divided into two groups. The patients in the remote ischemic preconditioning group (RIPC group) and the control group (control group) received three cycles of ischemic preconditioning before opening their chest after anesthesia and in the right lower extremity. Each cycle of pressurized tourniquet was inflated to 200mm Hg, maintained for 5 minutes, and then exhaled for 5 minutes. The levels of plasma creatine kinase isoenzyme MB isoenzyme of Creatine kinase CK-MBand cardiac troponin I cardiac c Tn I were measured before and after pretreatment and 48 hours after aorta opening. At the same time, the values of hemodynamics, blocking time, cardiopulmonary bypass (CPB), cardiac repulse rate, left ventricular ejection fraction (LVEF), preoperative and postoperative 24 hours creatinine and postoperative mechanical ventilation time were recorded before, during and after operation. Results there was no significant difference in the hemodynamic values between the two groups before operation and after operation (P 0.05). The time of postoperative mechanical ventilation was longer than that of ICU, and the time of hospitalization after operation was not significantly different between the two groups. There was no significant difference in the incidence of acute renal damage and the rate of new atrial fibrillation (P 0.05). However, the levels of CK-MB and c TnI in RIPC group were significantly lower than those in control group at 24 and 48 hours after aortic opening. Remote ischemic preconditioning may reduce the release of CK-MB and cTnI in patients undergoing valve replacement, but RIPC does not improve the short-term prognosis of these patients.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R654.2

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