心脏跳动中二尖瓣置换术心肌细胞凋亡临床探究.docVIP

心脏跳动中二尖瓣置换术心肌细胞凋亡临床探究 　【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（P＜0.01）；而实验组CPB前、后心肌细胞凋亡指数差异无显著性（P＞0.05）；CPB后，实验组心肌细胞凋亡指数较对照组明显降低（P＜0.01）。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 　　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 (Plt;0.01), while those in the experimental group showed no significant differences before and after CPB (Pgt;0.05). Compared with control group, myocyte apoptosis decreased significantly after CPB in experimental group(Plt;0.01). 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 surgery is less than that in traditional heart stop-beating. 　　Key words: open cardiac operation; myocytes, heart; cardiac myocyte apoptosis; mitral valve replacement 　　过去认为，细胞凋亡在不具备再生能力的细胞如成熟的心肌细胞、神经细胞中不再发生。但近些年的研究表明［1］，细胞凋亡同样存在于心肌细胞中，并且在心脏的生理、病理发展过程中起重要作用，被认为是心脏由代偿性变化向生理性、病理性变化发展的细胞学基础。对心肌细胞凋亡的研究，国外要比国内起步早，他们研究发现［2,3］，心肌细胞凋亡的原因主要是心肌的缺血和再灌注损伤引起。笔者于围术期间检测心肌细胞的凋亡情况，旨在进一步了解心脏跳动中施术与停跳手术这两种术式的心肌缺血和再灌注损伤程度，从而为完善围术期的心肌保护提供实验依据。 　　1 对象与方法 　　1.1 对象 　　选择30例同期行二尖瓣置换术的风心病患者，随机分为心脏跳动中施术组（实验组，n=16例）和传统中低温停跳手术组（对照组，n=14例）。两组患者性别、年龄、体重