本文選題：遠(yuǎn)端缺血預(yù)處理　切入點(diǎn)：心肌保護(hù)　出處：《安徽醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的研究遠(yuǎn)端缺血預(yù)處理(remote ischemic preconditioning,RIPC)對(duì)成年非重癥瓣膜置換患者圍手術(shù)期急性心肌損傷和臨床預(yù)后的影響。方法80名非重癥具有瓣膜置換指征成年住院患者被隨機(jī)分配到遠(yuǎn)端缺血預(yù)處理治療組(RIPC GROUP)和對(duì)照組(CONTROL GROUP)。RIPC組患者于麻醉后開胸前于在右下肢行3周期缺血預(yù)處理,每周期加壓止血帶充氣至200mm Hg,維持5分鐘,再放氣5分鐘。測(cè)定預(yù)處理前、預(yù)處理后,主動(dòng)脈開放后4、24、48小時(shí)各時(shí)間點(diǎn)血漿肌酸激酶同工酶(MB isoenzyme of Creatine Kinase,CK-MB)和肌鈣蛋白I(Cardiac Troponin,Ic Tn I)值,同時(shí)記錄術(shù)前、術(shù)中、術(shù)后的各時(shí)點(diǎn)血液動(dòng)力學(xué)數(shù)值,阻斷時(shí)間、體外循環(huán)時(shí)間,心臟自動(dòng)復(fù)跳率,術(shù)前及術(shù)后左室射血分?jǐn)?shù),術(shù)前及術(shù)后24、48小時(shí)肌酐值,術(shù)后機(jī)械通氣時(shí)間、術(shù)后新發(fā)房顫率、ICU停留時(shí)間以及術(shù)后住院時(shí)間。結(jié)果兩組間患者術(shù)前、術(shù)中和術(shù)后的血流動(dòng)力學(xué)數(shù)值組無(wú)明顯差異(P0.05),兩組患者術(shù)后機(jī)械通氣時(shí)間、ICU停留時(shí)間、術(shù)后住院時(shí)間,急性腎損害發(fā)生率、新發(fā)房顫率也無(wú)明顯差異(P0.05)。但RIPC組CK-MB值和c Tn I值的水平在主動(dòng)脈開放后4小時(shí)、24小時(shí)及48小時(shí)顯著低于對(duì)照組(P0.05)。結(jié)論本研究表明,遠(yuǎn)程缺血預(yù)處理可能降低接受瓣膜置換的患者CK-MB和c Tn I的釋放水平。然而,RIPC并沒(méi)有改善這些患者的短期臨床預(yù)后。
[Abstract]:Objective to study the effect of remote ischemic preconditioning (RIPC) on perioperative acute myocardial injury and clinical prognosis in adult non-severe valve replacement patients. Methods 80 non-severe adult inpatients with valvular replacement indication were randomly divided into two groups. The patients in the remote ischemic preconditioning group (RIPC group) and the control group (control group) received three cycles of ischemic preconditioning before opening their chest after anesthesia and in the right lower extremity. Each cycle of pressurized tourniquet was inflated to 200mm Hg, maintained for 5 minutes, and then exhaled for 5 minutes. The levels of plasma creatine kinase isoenzyme MB isoenzyme of Creatine kinase CK-MBand cardiac troponin I cardiac c Tn I were measured before and after pretreatment and 48 hours after aorta opening. At the same time, the values of hemodynamics, blocking time, cardiopulmonary bypass (CPB), cardiac repulse rate, left ventricular ejection fraction (LVEF), preoperative and postoperative 24 hours creatinine and postoperative mechanical ventilation time were recorded before, during and after operation. Results there was no significant difference in the hemodynamic values between the two groups before operation and after operation (P 0.05). The time of postoperative mechanical ventilation was longer than that of ICU, and the time of hospitalization after operation was not significantly different between the two groups. There was no significant difference in the incidence of acute renal damage and the rate of new atrial fibrillation (P 0.05). However, the levels of CK-MB and c TnI in RIPC group were significantly lower than those in control group at 24 and 48 hours after aortic opening. Remote ischemic preconditioning may reduce the release of CK-MB and cTnI in patients undergoing valve replacement, but RIPC does not improve the short-term prognosis of these patients.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R654.2

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本文編號(hào)：1576783