中国组织工程研究

中国组织工程研究

• 器官移植基础实验 basic experiments of organ transplantation • 上一篇    下一篇

改良心肌保护液在婴幼儿心内直视手术中的应用

程光存，程明光，汤丹丹，董贵福，蔡  燕，姜  波，严中亚   

  1. 安徽省心血管病研究所，安徽医科大学附属省立医院心脏外科，安徽省合肥市  230001
  • 收稿日期:2013-04-15 修回日期:2013-04-26 出版日期:2013-07-30 发布日期:2013-07-30
  • 通讯作者: 严中亚，硕士，教授，主任医师，安徽医科大学附属省立医院心脏外科，安徽省心血管病研究所，安徽省合肥市 230001 yan20047@163.com
  • 作者简介:程光存★，男，1967年生，安徽省舒城县人，汉族，2004年安徽医科大学毕业，硕士，副主任医师，主要从事心脏外科的基础和临床研究。 cunguangcheng@163.com
  • 基金资助:

    安徽省卫生厅科研计划课题(09A006)。

Application of myocardial protection fluid in infant open heart operation

Cheng Guang-cun, Cheng Ming-guang, Tang Dan-dan, Dong Gui-fu, Cai Yan, Jiang Bo, Yan Zhong-ya   

  1. Department of Cardiac Surgery, the Affiliated Provincial Hospital of Anhui Medical University, Anhui Institute of Cardiovascular Disease, Hefei  230001, Anhui Province, China
  • Received:2013-04-15 Revised:2013-04-26 Online:2013-07-30 Published:2013-07-30
  • Contact: Yan Zhong-ya, Master, Professor, Chief physician, Department of Cardiac Surgery, the Affiliated Provincial Hospital of Anhui Medical University, Anhui Institute of Cardiovascular Disease, Hefei 230001, Anhui Province, China yan20047@163.com
  • About author:Cheng Guang-cun★, Master, Associate chief physician, Department of Cardiac Surgery, the Affiliated Provincial Hospital of Anhui Medical University, Anhui Institute of Cardiovascular Disease, Hefei 230001, Anhui Province, China cunguangcheng@163.com
  • Supported by:

    Scientific Research Planning Project of Anhui Provincial Health Department, No. 09A006*

PDF

712

被引次数

2

摘要：

背景：目前国内外对于适合未成熟心肌停搏液的研究均未取得突破性进展，通过添加成分来提高现有停搏液对未成熟心肌的保护可能是一个较好的手段。腺苷能减轻缺血和中性粒细胞介导的再灌注损伤；丹参能降低缺血心肌脂质过氧化物含量，增加心肌细胞对氧自由基的清除。
目的：探讨添加腺苷和丹参的改良心肌保护液对心脏、肝脏、肾脏的保护作用。
方法：60例首次心内直视手术婴幼儿随机分为3组，各20例，腺苷组采用改良心肌保护液添加腺苷，联合组采用改良心肌保护液添加腺苷和丹参，对照组采用等容量的改良心肌保护液。于麻醉诱导前、体外循环开始后30 min、体外循环结束后30 min及体外循环结束后24 h采集患儿血标本，检测血清肌酸激酶同工酶、谷丙转氨酶、谷草转氨酶、尿素氮、肌酐、肿瘤坏死因子α、白细胞介素6、白细胞介素8、白细胞介素10水平变化。
结果与结论：3组患儿血清谷丙转氨酶、谷草转氨酶、尿素氮、肌酐、肌酸激酶同工酶均有升高，但是对照组升高最明显(P < 0.01)，腺苷组和联合组比较差异有显著性意义(P < 0.05)；肿瘤坏死因子α、白细胞介素6，白细胞介素8水平均比术前显著升高(P < 0.05)。对照组肿瘤坏死因子α、白细胞介素6、白细胞介素8明显高于诱导前以及相同时点腺苷组和联合组的水平(P < 0.01)；体外循环结束后30 min及24 h，3组白细胞介素10水平均明显增高，但腺苷组和联合组明显高于对照组(P < 0.01)。提示改良心肌保护液对未成熟心肌有良好的保护作用，能明显降低心内直视手术患儿血浆肿瘤坏死因子α、白细胞介素6、白细胞介素8水平，促进抑制炎细胞因子白细胞介素10的分泌，有效降低由体外循环引发的炎症反应，对心、肺、肝、肾等重要脏器有保护作用。

关键词: 器官移植, 器官移植基础实验, 体外循环, 心肌保护液, 腺苷注射液, 丹参注射液, 炎性因子, 肺保护, 心脏外科手术, 省级基金

Abstract:

BACKGROUND: The research at home and abroad for appropriate immature myocardial cardioplegia has no breakthrough, and it may be a better mean to improve the protection effect of existing cardioplegia on immature myocardial by adding ingredients. Adenosine can reduce ischemia and neutrophil-mediated reperfusion injury, and salvia miltiorrhiza can reduce the content of ischemic myocardial lipid peroxide and increase the scavenging of myocardial cells to oxygen radical.
OBJECTIVE: To investigate the protection effect of improved myocardial protection fluid containing adenosine and salvia miltiorrhiza on the heart, liver and kidney.
METHODS: Sixty cases of infant open heart operation of the first time were randomly divided into three groups, 20 cases in each group. The adenosine group received the improved myocardial protection fluid added with adenosine, the combination group received the improved myocardial protection fluid added with adenosine and miltiorrhiza salvia, and the control group received the improved myocardial protection fluid in the same volume. The blood samples were taken at the time before anesthesia induction, 30 minutes after cardio pulmonary bypass beginning, 1 hour after cardio pulmonary bypass end and 24 hours after cardio pulmonary bypass end. The serum levels of the creatine kinase, alanine aminotransferase, aspartate aminotransferase, blood urea nitrogen, creatinine, tumor necrosis factor-α, interleukin-6, interleukin-8 and interleukin 10 were detected.
RESULTS AND CONCLUSION: The serum levels of the alanine aminotransferase, aspartate aminotransferase, blood urea nitrogen, creatinine and creatine kinase in three groups were increased, but the control group was increased significantly (P < 0.01), and there were significant differences between adenosine group and combination group (P < 0.05); the levels of tumor necrosis factor-α, interleukin-6 and interleukin-8 were significantly increased after operation (P < 0.05). The levels of tumor necrosis factor-α, interleukin-6 and interleukin-8 in the control group were significantly higher than those in the adenosine group and combination group before induction and at the same time point (P < 0.01); at 3 minutes and 24 hours after cardio pulmonary bypass, the level of interleukin-10 was increased in three groups, but the level of interleukin-10 in the adenosine group was significantly higher than that in the control group (P < 0.01). The results indicate that improved myocardial protection fluid has great protection effect on immature myocardial, and can significantly reduce the serum levels of tumor necrosis factor-α, interleukin-6 and interleukin-8, promote the secretion of interleukin-10 that can inhibit inflammatory cytokine and can significantly reduce the inflammatory response caused by cardiopulmonary bypass. So the improved myocardial protection fluid has protection effect on important organs, such as heart, lung, liver and kidney.

Key words: organ transplantation, basic experiments of organ transplantation, cardiopulmonary bypass, myocardial protection fluid, adenosine injection, salvia miltiorrhiza injection, inflammatory factor, lung protection, cardiac surgical procedures, provincial grants-supported paper

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