去白细胞冷自体血停搏液减轻婴儿体外循环心脏手术心肌损伤作用的研究
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摘要
目的监测婴儿体外循环心脏病手术采用不同停搏液灌注前后不同时间点血清心脏脂肪酸结合蛋白(HHFABP)、肌钙蛋白I(c Tn I)及磷酸肌酸激酶同工酶(CKMB)的变化,探讨去白细胞冷自体血停搏液对减轻婴儿体外循环心脏手术心肌损伤的作用。方法采用临床对照研究,将年龄≤10月;体质量≤8 kg的100例患儿分为去白细胞冷自体血停搏液组(实验组)和冷自体血停搏液组(对照组)。分别于体外循环前及主动脉开放后30 min,1 h,6 h,12 h,24 h检测血清中HHFABP、c Tn I及CKMB的水平,超声检查获得对应时间点的左室射血分数(LVEF)。结果术前实验组和对照组HH-FABP、c Tn I、CKMB及LVEF差异无统计学意义,实验组术后各时间点HH-FABP、c Tn I及CKMB峰值均低于对照组,LVEF值高于对照组,HH-FABP峰值出现在术后1 h,c Tn I及CKMB峰值出现在术后24 h及12 h。结论去除冷自体血停搏液中白细胞可减轻婴儿体外循环心脏直视手术中心肌的损伤。
Objective By monitoring the levels of HH-FABP,c Tn I and CKMB at different time points before and after cardiac surgery with cardiopulmonary bypass,so as to evaluate the effect of leucocyte-depleted autologous cold blood cardioplegia on myocardial protection in infants. Methods A total of 100 infant patients were divided into two groups. Fifty patients were given leucocyte-depleted autologous cold blood cardioplegia as experimental group,while the other 50 patients were given autologous cold blood cardioplegia as control group. The levels of HH-FABP,c Tn I and CKMB in blood were examined before CPB and at 30 minutes,60 minutes,12 hours,24 hours after the removal of the aortic clamp. Also,the LVEF was checked accordingly. Results There was no significant difference between the two groups before aortic cross clamp removal. The levels of HH-FABP,c Tn I and CKMB of experimental group were significantly lower than those in control group,while the LVEF levels were higher. The levels of HH-FABP in both groups arrived peak values 60 minutes after aortic cross clamp removal. While the levels of cTnI and CKMB in both groups arrived the peak values 24 h and 12 h after aortic cross clamp removal. Conclusion The leucocyte-depleted autologous cold blood cardioplegia is effective to decrease myocardium injury of infants undergoing open-heart surgery with cardiopulmonary bypass.
Objective By monitoring the levels of HH-FABP,c Tn I and CKMB at different time points before and after cardiac surgery with cardiopulmonary bypass,so as to evaluate the effect of leucocyte-depleted autologous cold blood cardioplegia on myocardial protection in infants. Methods A total of 100 infant patients were divided into two groups. Fifty patients were given leucocyte-depleted autologous cold blood cardioplegia as experimental group,while the other 50 patients were given autologous cold blood cardioplegia as control group. The levels of HH-FABP,c Tn I and CKMB in blood were examined before CPB and at 30 minutes,60 minutes,12 hours,24 hours after the removal of the aortic clamp. Also,the LVEF was checked accordingly. Results There was no significant difference between the two groups before aortic cross clamp removal. The levels of HH-FABP,c Tn I and CKMB of experimental group were significantly lower than those in control group,while the LVEF levels were higher. The levels of HH-FABP in both groups arrived peak values 60 minutes after aortic cross clamp removal. While the levels of cTnI and CKMB in both groups arrived the peak values 24 h and 12 h after aortic cross clamp removal. Conclusion The leucocyte-depleted autologous cold blood cardioplegia is effective to decrease myocardium injury of infants undergoing open-heart surgery with cardiopulmonary bypass.
引文
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[2]杨桐,张永强,王江,等.去白细胞含血停搏液对成人心脏手术患者心肌保护效果的Meta分析[J].中国循证医学杂志,2016,16(5):543-549.
[3] Talwar S,Bhoje A,Sreenivas V,et al. Comparison of del nido and st thomas cardioplegia solutions in pediatric patients:a prospective randomized clinical trial[J]. Semin Thorac Cardiovasc Surg,2017,29(3):366-374.
[4] Mimic B,Ilic S,Vulicevic I,et al. Comparison of high glucose concentration blood and crystalloid cardioplegia in paediatric cardiac surgery:a randomized clinical trial[J]. Interact Cardiovasc Thorac Surg,2016,22(5):553-560.
[5] Münch F,Purbojo A,Kellermann S,et al. Improved contractility with tepid modified full blood cardioplegia compared with cold crystalloid cardioplegia in a piglet model[J]. Eur J Cardiothorac Surg,2015,48(2):236-243.
[6] Kotani Y,Tweddell J,Gruber P,et al. Current cardioplegia practice in pediatric cardiac surgery:a north american multiinstitutional survey[J]. Ann Thorac Surg,2013,96(3):923-929.
[7] Mc Donald CI,Fraser JF,Coombes JS,et al. Oxidative stress during extracorporeal circulation[J]. Eur J Cardiothorac Surg,2014,46(6):937-943.
[8]王石雄,李宁荫,高秉仁.心脏型脂肪结合蛋白的研究及在心脏外科的应用[J].中国组织工程研究,2012,16(28):5297-5303.
[9]刘银河,周义文,涂植光,等.心肌型脂肪酸结合蛋白对心外科围术期心肌缺血与损伤的预测价值[J].中华心血管病杂志,2010,38(6):514-517.
[10] Muehlschlegel JD,Perry TE,Liu KY,et al. Heart-type fatty acid binding protein is an independent predictor of death and ventricular dysfunction after coronary artery bypass graft surgery[J].Anesth Analg,2010,111(5):1101-1109.
[11] Onorati F,Santini F,Menon T,et al. Leukocyte filtration of blood cardioplegia attenuates myocardial damage and inflammation[J]. Eur J Cardiothorac Surg,2013,43(1):81-89.