本文選題：無創(chuàng)性缺血后處理 + 下肢缺血后處理��； 參考：《新鄉(xiāng)醫(yī)學(xué)院》2012年碩士論文

【摘要】：目的缺血后處理作為一種內(nèi)源性心肌保護方式,能夠明顯減輕心肌的缺血-再灌注損傷,改善心肌功能,是缺血預(yù)處理的發(fā)展。而遠(yuǎn)距離缺血后處理作為經(jīng)典缺血后處理的發(fā)展,具有可預(yù)知性及易操控性,在心肌缺血-再灌損傷中的保護作用得到大量動物實驗證實,其中無創(chuàng)性肢體缺血后處理以其無創(chuàng)、簡便的優(yōu)點,近年來在動物實驗中研究較多,但臨床報道較少。本實驗從臨床不同角度研究遠(yuǎn)距離無創(chuàng)性肢體缺血后處理對小兒法樂四聯(lián)癥體外循環(huán)根治術(shù)中心肌缺血-再灌注損傷的保護作用,為臨床應(yīng)用提供理論依據(jù)。 資料和方法本實驗選擇2010年10月至2011年12月中國武警總醫(yī)院心血管外科收治的法樂四聯(lián)癥根治手術(shù)患兒50例,年齡范圍6月-7歲�；純弘S機分為兩組：實驗組(下肢缺血后處理組,n=25)和對照組(n=25)。實驗組于左下肢距膝關(guān)節(jié)上方1-2cm處綁縛氣壓袖帶,在阻斷主動脈的同時給予充氣加壓,壓力維持根據(jù)患兒具體年齡及體重情況波動在150-200mmHg,以足背動脈搏動消失、經(jīng)皮末梢氧飽和度監(jiān)測呈直線為準(zhǔn),持續(xù)3分鐘后松開氣囊,3分鐘后再次加壓,循環(huán)3個周期。對照組常規(guī)體外循環(huán)手術(shù),不進行肢體缺血操作。分別記錄兩組主動脈阻斷時間、體外循環(huán)轉(zhuǎn)流時間、心臟自動復(fù)跳比率,復(fù)跳后心律失常發(fā)生率和術(shù)后24小時內(nèi)正性肌力藥物計分、呼吸機輔助時間、滲漏綜合征及低心排出量綜合征發(fā)生率；兩組分別于術(shù)前、主動脈開放后1小時、6小時、24小時抽取靜脈血測定血清肌酸激酶同工酶、肌紅蛋白及肌鈣蛋白Ⅰ。 結(jié)果兩組患兒術(shù)前各項指標(biāo)包括性別、年齡、體重、血紅蛋白、末梢氧飽和度、McGoon指數(shù)、左室舒張末容積指數(shù)、肌紅蛋白、肌酸激酶同工酶、肌鈣蛋白Ⅰ以及術(shù)中主動脈阻斷時間、體外循環(huán)轉(zhuǎn)流時間均無統(tǒng)計學(xué)上的差異性(P0.05)。實驗組患兒的心臟自動復(fù)跳率較對照組有所增高,術(shù)后呼吸機輔助時間、滲漏綜合征及低心排出量綜合征的發(fā)生率均較對照組低,但均無明顯差異(P0.05)；復(fù)跳后心律失常發(fā)生率和正性肌力藥物計分較對照組降低,具有統(tǒng)計學(xué)差異(P0.05)。主動脈開放后1小時后兩組間的肌酸激酶同工酶、肌紅蛋白和肌鈣蛋白Ⅰ均無統(tǒng)計學(xué)籌異(P0.05),兩組的肌紅蛋白較術(shù)前均明顯增高(P0.05)；在主動脈開放后6小時、24小時兩組的肌酸激酶同工酶、肌紅蛋白和肌鈣蛋白Ⅰ較術(shù)前均有明顯升高,且實驗組的肌酸激酶同工酶、肌紅蛋白和肌鈣蛋白Ⅰ均較對照組降低(P0.05),開放6小時時兩組間肌酸激酶同工酶、肌紅蛋白和肌鈣蛋白Ⅰ均有統(tǒng)計學(xué)差異(P0.05),開放后24小時時兩組間肌鈣蛋白Ⅰ有統(tǒng)計學(xué)差異(P0.05)。 結(jié)論無創(chuàng)性下肢缺血后處理組可以明顯減少復(fù)跳后心律失常發(fā)生率及正性肌力藥物用量；無創(chuàng)性下肢缺血后處理可以減輕小兒法樂四聯(lián)癥根治術(shù)體外循環(huán)中的缺血.-再灌注損傷,對心肌具有一定的保護作用。
[Abstract]:Objective as an endogenous myocardial protection method, ischemic post-treatment can significantly reduce myocardial ischemia-reperfusion injury and improve myocardial function, which is the development of ischemic preconditioning. However, as the development of classical ischemic postprocessing, the long distance ischemic postprocessing has the characteristics of predictability and maneuverability. The protective effect in myocardial ischemia reperfusion injury has been confirmed by a large number of animal experiments. Among them, noninvasive post-treatment of limb ischemia, with its advantages of non-invasive and simple, has been studied in animal experiments in recent years, but there are few clinical reports. The purpose of this study was to study the protective effect of long distance noninvasive limb ischemia post-treatment on myocardial ischemia-reperfusion injury in children with tetralogy of Fallot during cardiopulmonary bypass (CPB) from different clinical angles, and to provide theoretical basis for clinical application. Materials and methods 50 children with tetralogy of Fallot, aged from 6 to 7 years old, were selected from October 2010 to December 2011 in Cardiovascular surgery, China Armed Police General Hospital. The children were randomly divided into two groups: experimental group (post-ischemic treatment group) and control group. In the experimental group, the pressure cuff was tied to the upper 1-2cm of the knee joint in the left lower extremity, and the aortic artery was blocked with inflatable pressure. The pressure maintained fluctuated from 150 to 200 mm Hg according to the specific age and weight of the child, and disappeared as the pulsatile of the dorsal foot artery. The oxygen saturation at the end of the skin was monitored in a straight line. After 3 minutes, the oxygen saturation was released and then pressurized again after 3 minutes, followed by 3 cycles of circulation. In the control group, the routine cardiopulmonary bypass operation was not performed. The aortic occlusion time, cardiopulmonary bypass (CPB) rate, the incidence of arrhythmia after cardiopulmonary bypass (CPB), the incidence of cardiac arrhythmias, the score of positive muscle strength drugs within 24 hours after cardiopulmonary bypass, and the time of ventilator were recorded The incidences of leakage syndrome and low cardiac output syndrome were measured before operation and 6 hours after aortic opening and 24 hours after aortic opening. Serum creatine kinase isoenzyme, myoglobin and troponin 鈪，

本文編號：1871998