心脏跳动中二尖瓣置换术心肌细胞凋亡的临床研究.docVIP

心脏跳动中二尖瓣置换术心肌细胞凋亡的临床研究 　　作者：李逢昌，黄健辉，何巍 作者单位：1.广西柳州市人民医院，广西医科大学第五附属医院心胸外科，广西，柳州，545001;2.广西医科大学附属第一医院心胸外科，广西，南宁，530021 　　【摘要】 目的 检测心脏跳动中二尖瓣置换术患者心肌细胞凋亡情况。方法 将同期30例风心二尖瓣膜疾病患者随机分为实验组(浅低温心脏跳动中施术组)与对照组(中低温传统停跳施术组)。分别于心肺转流术(CPB)前，停机时留取右心房肌标本，采用原位细胞凋亡检测试剂盒，扫描电镜检测心肌细胞的细胞凋亡情况。结果 与CPB前比较，对照组CPB后心房肌细胞凋亡指数明显升高(P0.01);而实验组CPB前、后心肌细胞凋亡指数差异无显著性(P0.05);CPB后，实验组心肌细胞凋亡指数较对照组明显降低(P0.01)。结论 在心脏跳动中二尖瓣置换术心肌细胞的细胞凋亡指数明显低于传统停跳手术组，说明心脏跳动中施术对心肌细胞的缺血和再灌注损伤要比传统停跳手术小。 　　【关键词】 心内直视手术 肌细胞 心脏 心肌细胞凋亡 瓣膜置换术 　　A clinical study on cardiac myocyte apoptosis in beating heart mitral valve replacement 　　LI Feng-chang, HUANG Jian-hui, HE Wei 　　(1. Cardiac Surgery Department, the Peoples Hospital of Liuzhou City, the Fifth Affiliated Hospital of Guangxi Medical University, Liuzhou, Guangxi 545001, China; 2. Cardiac Surgery Department, the First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530021, China) 　　Abstract: Objective To investigate the apoptosis of the cardiac myocyte in mitral valve replacement while heart beating. Methods 30 patients with rheumatic mitral valvular heart diseases were divided into two groups: 15 patients in experimental group (aorta unclamped and mild hypothermia) and 15 ones in control group (aorta cross-clamped and moderate hypothermia). Samples of the right atrial were obtained before and after cardiopulmonary bypass (CPB) and the myocyte apotosis were examed via TUNEL reagents boxes and scanning electron microscopy. Results Compared to pre-CPB, myocyte apoptosis in control group increased significantly after CPB (P0.01), while those in the experimental group showed no significant differences before and after CPB (P0.05). Compared with control group, myocyte apoptosis decreased significantly after CPB in experimental group(P0.01). Conclusion The myocyte apoptosis in heart beating mitral valve replacement is apparently less than that while heart arrest, which indicates myocyte ischemia and reperfusion injury induced by heart beating s