挥发性麻醉药预处理减轻2型糖尿病患者体外循环心脏手术缺血再灌注损伤

发布时间：2018-10-25 12:57

【摘要】：研究背景：缺血预处理和挥发性麻醉药均已证实对心肌缺血再灌注具有保护作用,但缺血预处理对于糖尿病心肌是否具有保护作用还存在争议. 研究目的：采用七氟醚预处理,观察其对糖尿病和非糖尿病患者体外循环下心脏手术心肌影响及术后转归,探讨挥发性麻醉药预处理对糖尿病心肌的有无保护作用. 研究方法：选择20例为合并糖尿病择期心脏手术患者以及20例为非糖尿病心脏手术患者,均随机分为2组,一组为七氟醚预处理组,在建立体外循环前吸入1MAC七氟醚5分钟,然后用氧气将七氟醚洗出,反复进行3次,另一组未处理组,测定TnI和CK-MB作为心肌损伤指标,取部分右心耳组织采用Western-Blot检测PKC,PTEN, STAT3, eNOS, AKT的活性. 结果：术前各组临床资料无显著差异,未处理糖尿病患者组和七氟醚预处理糖尿病患者组术后5小时Tn1分别为2.1±1.03ng/ml和165±0.65ng/ml,CK-MB分别为39.2+3ng/ml和36.3±4ng/ml在非糖尿病患者中,未处理组和七氟醚处理组分别为16±0.62ng/ml和1.2±2.45ng/ml, CK-MB分别为28.5±3.4ng/ml和21.4±5.6ng/ml. Western-Blot显示仅仅在PKC和总STAT3有差异。未处理组术后在ICU带管时间和停留时间均明显长于七氟醚预处理组。结论：七氟醚预处理可以产生较好的心脏保护作用,能改善术后心脏功能,对合并糖尿病的心脏病患者也能产生较好的保护作用,该结果还有待于更大规模的临床实验和长期追踪予以证实。
[Abstract]:Background: ischemic preconditioning and volatile anesthetics have been proved to have protective effects on myocardial ischemia-reperfusion, but whether ischemic preconditioning has protective effect on diabetic myocardium is still controversial. Objective: to observe the effect of sevoflurane pretreatment on myocardium of diabetic and non-diabetic patients during cardiopulmonary bypass (CPB) and to explore the protective effect of volatile anesthetic pretreatment on myocardium of diabetic patients after cardiopulmonary bypass (CPB). Methods: twenty patients with diabetes mellitus undergoing elective cardiac surgery and 20 patients with non-diabetic cardiac surgery were randomly divided into two groups: one group was pretreated with sevoflurane and inhaled sevoflurane for 5 minutes before cardiopulmonary bypass (CPB). Then, sevoflurane was washed out with oxygen and repeated for 3 times. In another group, TnI and CK-MB were measured as myocardial injury indexes. Western-Blot was used to detect the activity of PKC,PTEN, STAT3, eNOS, AKT in some right auricular tissues. Results: there was no significant difference in the clinical data of each group before operation. The Tn1 of untreated diabetic group and sevoflurane pretreated diabetic group was 2.1 卤1.03ng/ml and 165 卤0.65ng / ml CK-MB 39.2 3ng/ml and 36.3 卤4ng/ml, respectively. In untreated group and sevoflurane group, 16 卤0.62ng/ml and 1.2 卤2.45 ng / ml, CK-MB were 28.5 卤3.4ng/ml and 21.4 卤5.6 ng / ml, respectively. Western-Blot shows only differences between PKC and total STAT3. The postoperative time and residence time of ICU in untreated group were significantly longer than that in sevoflurane pretreatment group. Conclusion: sevoflurane pretreatment can produce better cardioprotective effect, improve cardiac function after operation, and protect heart disease patients with diabetes mellitus. The results have yet to be confirmed in larger clinical trials and long-term follow-up.
【学位授予单位】：华中科技大学
【学位级别】：博士
【学位授予年份】：2015
【分类号】：R614

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