ACE抑制剂在CPB围术期心肌保护中机制研究.docVIP

ACE抑制剂在CPB围术期心肌保护中机制研究 　　【摘要】 目的：通过观察心肌标志物的变化，探究ACE抑制剂在CPB围术期心肌保护中的机制。方法：选取本院从2015年1-10月所接诊的72例风湿性的二尖瓣狭窄患者，根据多态性的ACE基因将患者分为II、ID和DD三组，每组各24例，在不同的时刻点抽取三组的外周静脉血，对其ACE及心肌标志物的含量变化进行检测与对比。结果：ACE及心肌标志物在CPB后及CPB中的含量均高于CPB前的，DD型血清中ACE及心肌标志物的含量都比ID型及II型的高，差异均有统计学意义（P0.05）。结论：ACE抑制剂可以降低在CPB围手术时心肌的长时间缺血后进行的再灌注的心肌细跑损伤，提高了手术的安全性，值得推广和应用。 　　【关键词】 ACE； ACE基因多态性； CPB围手术期； 心肌损伤 　　The Mechanism of ACE Inhibitor in the Protection of Myocardial during CPB/YANG Wei，DONG Xiao，ZHOU Jian-liang，et al.//Medical Innovation of China，2015，12（34）：020-022 　　【Abstract】 Objective：To investigate the relationship between ACE gene polymorphism and myocardial protection during perioperative period of CPB through observe the change of myocardial markers.Method：72 patients who suffered from rheumatic mitral stenosis in our hospital were selected from January to October 2015. According to the genotype of ACE they were divided into three groups：type Ⅱ group，type ID group and type DD group，24 cases in each group.The peripheral venous blood of three groups were selected at different moments， the ACE and the content changes of myocardial markers were detected and compared.Result：The level of ACE during CPB and after CPB were higher then those before CPB，the level of ACE with DD genotype was significantly higher than the ID and Ⅱ genotype， the differences were statistically significant（P0.05）. Conclusion：ACE inhibitors reduce myocardial cells injury at CPB perioperative after myocardial cells live myocardial longer ischaemia and then reperfusion， improve the safety of surgery，it is worthy of promotion and application. 　　【Key words】 ACE； ACE gene polymorphism； CPB perioperative； Myocardial injury 　　First-author’s address：The Second Affiliated Hospital of Nanchang University，Nanchang 330008，China 　　doi：10.3969/j.issn.1674-4985.2015.34.006 　　大量的临床研究表明，造成非心脏手术患者在围术期死亡的最主要的原因是患者在围术期时心肌的缺血[1]。然而根据目前的研究水平，还无法解释患者在围术期时心肌缺血，它可能与麻醉导致的冠状动脉的病变及进一步狭窄有关。血管紧张素转换酶（ACE）作为肾素-血管紧张素-醛固酮整个系统中的一种重要酶，ACE基因存在于染色体17q23中，由于插入（