中国组织工程研究

中国组织工程研究 ›› 2012, Vol. 16 ›› Issue (18): 3259-3262.doi: 10.3969/j.issn.1673-8225.2012.18.007

• 心肺移植 heart-lung transplantation • 上一篇    下一篇

老年患者浅低温心脏不停跳瓣膜置换中的心肌保护*☆

周  涛，何  巍，谢晓勇   

  1. 广西医科大学第一附属医院胸心外科，广西壮族自治区南宁市 530021
  • 收稿日期:2011-12-01 修回日期:2012-01-11 出版日期:2012-04-29 发布日期:2012-04-29
  • 通讯作者: 何巍，教授，广西医科大学第一附属医院胸心外科，广西壮族自治区南宁市530021 gxnnheart@sina.com
  • 作者简介:周涛☆，男，1975年生，汉族，湖南省武冈市人，广西医科大学在读博士，副主任医师，主要从事不停跳心脏手术的基础与临床研究。chowtao@sina.com
  • 基金资助:

    广西2011年研究生教育创新计划资助项目(2011105981002D33)。

Myocardial protective effects of on-pump beating-heart technique with mild hypothermia for elderly patients undergoing valve replacement

Zhou Tao, He Wei, Xie Xiao-yong   

  1. Department of Thoracic and Cardiovascular Surgery, First Affiliated Hospital of Guangxi Medical University, Nanning  530021, Guangxi Zhuang Autonomous Region, China
  • Received:2011-12-01 Revised:2012-01-11 Online:2012-04-29 Published:2012-04-29
  • Contact: He Wei, Professor, Department of Thoracic and Cardiovascular Surgery, First Affiliated Hospital of Guangxi Medical University, Nanning 530021,Guangxi Zhuang Autonomous Region, China gxnnheart@sina.com
  • About author:Zhou Tao☆, Studying for doctorate, Associate chief physician, Department of Thoracic and Cardiovascular Surgery, First Affiliated Hospital of Guangxi Medical University, Nanning 530021,Guangxi Zhuang Autonomous Region, China chowtao@sina.com
  • Supported by:

    Innovation Projects of Guangxi Graduate Education in 2011, No.2011105981002D33*

PDF

262

被引次数

4

摘要：

背景：体外循环心内直视手术引起的心肌损害是术后并发症发生的重要原因，浅低温心脏不停跳技术有明显的心肌保护作用，对某些高危患者尤为有益。
目的：观察浅低温体外循环心脏不停跳瓣膜置换对老年患者的心肌保护作用。
方法：选择年龄≥60岁择期行二尖瓣人工瓣膜置换的风湿性心脏病患者30例，根据治疗方式分为2组，停跳组在中度低温心脏停跳下完成心脏瓣膜置换，不停跳组在浅低温心脏跳动中完成心脏瓣膜置换。
结果与结论：在转机30 min、术中关闭右心房前，两组患者肿瘤坏死因子α、白细胞介素6，8、心肌肌钙蛋白Ⅰ浓度较转机前时升高(P < 0.05)，其中以停跳组明显(P < 0.05)。关闭右心房时两组核转录因子κB的表达增加，以不停跳组增加幅度较小(P < 0.05)。提示浅低温心脏不停跳技术可以减轻老年患者体外循环心内直视手术过程中的心肌损害，该作用可能与减轻心肌的局部炎症反应有关。
 

关键词: 体外循环, 不停跳手术, 心脏瓣膜置换, 炎症, 心肌保护, 老年人

Abstract:

BACKGROUND: Myocardial damage caused by open heart surgery involving cardiopulmonary bypass (CPB) is one of the most common causes of postoperative complications. On-pump beating-heart technique with mild hypothermia is benefit to the high-risk patients due to its myocardial protective effect.
OBJECTIVE: To investigate myocardial protective effects of on-pump beating-heart technique with mild hypothermia on elderly patients undergoing valve replacement with CPB.
METHODS: Thirty elderly patients undergoing elective artificial heart mitral valve replacement with CPB were eligible for inclusion in the study. The patients were divided into two groups according to the treatment method: in the control group, the heart valve replacement was completed under moderate hypothermia, and in the beating heart group, the heart valve replacement was completed under mild hypothermia.
RESULTS AND CONCLUSION: Compared with before CPB, the concentration of tumor necrosis factor-alpha, interleukin 6, interleukin 8 and cardiac troponinⅠwere increased at 30 minutes after the start of CPB, and before the right atrium was closed during operation (P < 0.05), and the changes were obvious in control group (P < 0.05). The expression of nuclear transcription factor kappa B was increased when the right atrium was closed, but the increased expression of nuclear transcription factor kappa B in beating heart group was smaller in the two groups (P < 0.05). On-pump beating-heart technique with mild hypothermia can significantly decrease the myocardial damage in open heart operation with CPB in elderly patients which may relate with the decreasing of the myocardial inflammatory response. 

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