“缺血后适应”用于深低温停循环器官保护效应研究
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摘要
目的探讨"缺血后适应"对于深低温停循环器官损伤的保护效应。方法将12只健康成年巴马香猪随机分为深低温停循环组(A组)与深低温停循环缺血后适应组(B组),每组各6只。两组均经颈总动脉和颈内静脉插管建立体外循环,转流并降温至直肠温度为15℃,暂停循环90 min后恢复体外循环并复温,先后脱离体外循环、呼吸机辅助。B组在恢复体外循环之初,进行3个轮回的灌注30 s/阻断30 s操作。术后1、3、7 d抽血检测两组实验动物的谷丙转氨酶(ALT)、谷草转氨酶(AST)、肌酐(Cr)、肌钙蛋白(TNT)。结果所有动物均顺利度过围术期。两组动物麻醉诱导后、转流初期、停循环、心脏复跳、脱离体外循环等时间点的血压、心率、直肠温度等生命体征数据比较,差异无统计学意义(P> 0. 05)。术后第1天,A组动物的ALT、Cr、TNT均明显高于B组,组间比较,差异有统计学意义(P <0. 05);两组AST比较,差异无统计学意义(P>0. 05)。术后第3天及第7天,A组动物ALT、AST、Cr及TNT指标仍稍高于B组,但差异均无统计学意义(P> 0. 05)。结论缺血后适应有缓解深低温停循环术后近期肝、肾、心等多器官损伤的趋势,以术后第1天效果最为显著。
Objective To investigate the effect of ischemic postconditioning( IPOC) on organ protection after deep hypothermia circulatory arrest( DHCA). Methods A total of 12 healthy adult Bama minipigs were randomly divided into the Group A( DHCA group)and Group B( DHCA + IPOC group),with 6 pigs in each group. Two groups were established by the common carotid artery and internal jugular vein intubation extracorporeal circulation,transfer flow and cooling to the rectal temperature of 15℃,the suspension loop 90 minutes after recovery of extracorporeal circulation and temperature,successively from the extracorporeal circulation,then breathing machine auxiliary. At the beginning of the recovery of extracorporeal circulation,Group B carried out perfusion of 30 seconds/block of30 seconds for 3 cycles. The alanine transaminase( ALT),glutamic oxalacetic transaminase( AST),creatinine( Cr) and troponin( TNT) of the two groups of experimental animals were measured with blood drawn 1,3 and 7 days after operation. Results All animals passed through perioperative period successfully. There was no statistically significant difference( P > 0. 05) in the vital signs of blood pressure,heart rate and rectal temperature of the two groups at the time points of anesthesia induction,initial transposition,cessation of circulation,cardiac repulse,and extracorporeal circulation. On the first day after surgery,ALT,Cr and TNT were significantly higher in Group A than those of Group B( P < 0. 05). The AST of the two groups showed no significant difference( P > 0. 05). On the3 rd and 7th day after surgery,the above indicators were still slightly higher in Group A than those of Group B,while the difference was not statistically significant( P > 0. 05). Conclusion IPOC can help to alleviate multiple organ injury of liver,kidney and heart after DHCA. The benefit in the first day after operation is more significant.
Objective To investigate the effect of ischemic postconditioning( IPOC) on organ protection after deep hypothermia circulatory arrest( DHCA). Methods A total of 12 healthy adult Bama minipigs were randomly divided into the Group A( DHCA group)and Group B( DHCA + IPOC group),with 6 pigs in each group. Two groups were established by the common carotid artery and internal jugular vein intubation extracorporeal circulation,transfer flow and cooling to the rectal temperature of 15℃,the suspension loop 90 minutes after recovery of extracorporeal circulation and temperature,successively from the extracorporeal circulation,then breathing machine auxiliary. At the beginning of the recovery of extracorporeal circulation,Group B carried out perfusion of 30 seconds/block of30 seconds for 3 cycles. The alanine transaminase( ALT),glutamic oxalacetic transaminase( AST),creatinine( Cr) and troponin( TNT) of the two groups of experimental animals were measured with blood drawn 1,3 and 7 days after operation. Results All animals passed through perioperative period successfully. There was no statistically significant difference( P > 0. 05) in the vital signs of blood pressure,heart rate and rectal temperature of the two groups at the time points of anesthesia induction,initial transposition,cessation of circulation,cardiac repulse,and extracorporeal circulation. On the first day after surgery,ALT,Cr and TNT were significantly higher in Group A than those of Group B( P < 0. 05). The AST of the two groups showed no significant difference( P > 0. 05). On the3 rd and 7th day after surgery,the above indicators were still slightly higher in Group A than those of Group B,while the difference was not statistically significant( P > 0. 05). Conclusion IPOC can help to alleviate multiple organ injury of liver,kidney and heart after DHCA. The benefit in the first day after operation is more significant.
引文
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[13] Stone GW,Dixon SR,Grines CL,et al. Predictors of infarct size after primary coronary angioplasty in acute myocardial infarction from pooled analysis from four contemporary trials[J]. Am J Cardiol,2007,100(9):1370-1375.
[14] Gao J,Luo J,Liu F,et al. Short-and long-term effects of ischemic postconditioning in STEMI patients:a meta-analysis[J]. Lipids Health Dis,2015,14:147.
[2] Alam HB,Duggan M,Li Y,et al. Putting life on hold-for how long Profound hypothermic cardiopulmonary bypass in a Swine model of complex vascular injuries[J]. J Trauma,2008,64(4):912-922.
[3] Staat P,Rioufol G,Piot C,et al. Postconditioning the human heart[J]. Circulation,2005,112(14):2143-2148.
[4] Taylor MJ,Bailes JE,Elrifai AM,et al. A new solution for life without blood. Asanguineous low-flow perfusion of a whole-body perfusate during 3 hours of cardiac arrest and profound hypothermia[J]. Circulation,1995,91(2):431-444.
[5] Tseng EE,Brock MV,Lange MS,et al. Glutamate excitotoxicity mediates neuronal apoptosis after hypothermic circulatory arrest[J]. Ann Thorac Surg,2010,89(2):440-445.
[6] Garcia S,Rector TS,Zakharova M,et al. Cardiac remote ischemic preconditioning prior to elective vascular surgery(CRIPES):a prospective,randomized,sham-controlled phaseⅡclinical trial[J]. J Am Heart Assoc,2016,5(10). pii:e003916.
[7] Zhao H,Sapolsky RM,Steinberg GK. Interrupting reperfusion as a stroke therapy:ischemic postconditioning reduces infarct size after focal ischemia in rats[J]. J Cereb Blood Flow Metab,2006,26(9):1114-1121.
[8] Jonker SJ,Menting TP,Warle MC,et al. Preclinical evidence for the efficacy of ischemic postconditioning against renal ischemiareperfusion injury,a systematic review and meta-analysis[J].PLo S One,2016,11(3):e0150863.
[9] Safaei N,Sheikhalizadeh MA,Badalzadeh R. Effect of ischemic postconditioning on myocardial protection in patients undergoing coronary artery bypass grafting surgery with cardiopulmonary bypass[J]. J Cardiovasc Thorac Res,2016,8(2):65-71.
[10] Robert R,Ghazali DA,Favreau F,et al. Gender difference and sex hormone production in rodent renal ischemia reperfusion injury and repair[J]. J Inflamm(Lond),2011,8:14.
[11] Przyklenk K. Efficacy of cardioprotective'conditioning'strategies in aging and diabetic cohorts:the co-morbidity conundrum[J].Drugs Aging,2011,28(5):331-343.
[12] Mc Cafferty K,Forbes S,Thiemermann C,et al. The challenge of translating ischemic conditioning from animal models to humans:the role of comorbidities[J]. Dis Model Mech,2014,7(12):1321-1333.
[13] Stone GW,Dixon SR,Grines CL,et al. Predictors of infarct size after primary coronary angioplasty in acute myocardial infarction from pooled analysis from four contemporary trials[J]. Am J Cardiol,2007,100(9):1370-1375.
[14] Gao J,Luo J,Liu F,et al. Short-and long-term effects of ischemic postconditioning in STEMI patients:a meta-analysis[J]. Lipids Health Dis,2015,14:147.