开放升主动脉时降低氧流量复灌对心肌肌钙蛋白I水平的影响.docVIP

开放升主动脉时降低氧流量复灌对心肌肌钙蛋白I水平的影响 作者:李志东,陈胜喜,刘晓丽 作者单位：株洲三三一医院心胸外科，湖南 株洲 412002 【摘要】 目的 探讨体外循环心内直视术中升主动脉开放早期短时降低氧流量复灌对心肌肌钙蛋白（cTnI）的影响。方法 选择30例术中应用鼓泡式氧合器的心脏病患者随机分为高氧流量复灌组（组Ⅰ，n=10）、低氧流量复灌组 (组Ⅱ， n=10)和低氧、低血流量复灌组(组Ⅲ, n=10)。常规体外循环下进行手术，升主动脉开放时改变各组复灌氧流量，分别于术前（T0）、开放升主动脉后30 min（T1）、术后6 h（T2）、24 h（T3）、48 h（T4）各时间点抽取患者锁骨下静脉血2 ml，采用ELISA酶联免疫法测定血浆cTnI含量。结果 本组资料显示：①组Ⅰ与组Ⅱ血浆cTnI含量术后48 h内有显著性差异（P0.05）；②组Ⅰ与组Ⅲ血浆cTnI含量术后48 h内有显著性差异（P0.05）；③组Ⅱ与组Ⅲ血浆cTnI含量无显著性差异；④三组开放升主动脉后30 min、术后6 h、24 h、48h血浆cTnI含量与术前相比有显著性差异 (P0.05)。结论 ①开放循环早期短时低氧流量灌注能够减少心肌cTnI的释放、降低心肌细胞的损伤；②改变原有体外循环手术中的给氧策略可能是有益的探索。 【关键词】 低氧流量；体外循环；心肌肌钙蛋白I 　　The Influence of Reperfusion by Debasing Oxygen Flux in the Early Time of Open Aorta to the Cardiac Troponin I 　　LI Zhi-dong，CHEN Sheng-xi，LIU Xiao-li 　　( Department of Cardiovascular Surgery of Zhuzhou 331 Hospital, Hunan Zhuzhou 412002;Department of Cardiovascular Surgery of Xinagya Hospital，Hunan Changsha 410008，China) 　　Abstract: OBJECTIVE To discuss the influence upon the cardiac troponin I (cTnl) by short time debasing oxygen flux in the early time of open aorta during cardiac operation with extracorporeal circulation(ECC).METHODS 30 patients with heart disease undergoing open heart surgery with ECC were randomly divided into three groups: the high oxygen flux reperfusion group (groupⅠ, n=10) , the low oxygen flux reperfusion group (group Ⅱ, n=10) and the low oxygen and low perfusion flux reperfusion group (group Ⅲ, n=10). At the time of aorta opening in routine cardiac surgeries with ECC,the oxygen flux was changed respectively. Two millilitres blood was taken at the time of pre-operation（T0）,30 min after aorta opening（T1）,6 h (T2),24 h (T3) and 48 h after operation (T4) to measure the levels of serum cTnI were measured through ELISA method.RESULTS The level of serum cTnI of group Ⅰ had significant difference compared with group Ⅱ and group Ⅲ （P0.05）, but there was no significant difference between groupⅡ and group Ⅲ （P0.05）. Compar