Li G, Chen S, Lou W, Jiang H
Department of Thoracic and Cardiovascular Surgery, Xiangya Hospital, Hunan Medical University, Changsha.
Hunan Yi Ke Da Xue Xue Bao. 1998;23(1):41-3.
Twenty direct vision intracardial operation patients were divided into two groups randomly. After cardiopulmonary bypass, ten patients were treated with myocardial ischemic preconditioning. The aorta were clamped for 3 minutes and released for 3 minutes (Group IP). Another ten patients were not treated with ischemic preconditioning (Group C), only underwent 6 minutes cardiopulmonary bypass. Then the aorta were clamped and intracardial operation were done. The left atrium blood and lung tissue were collected just after thoractomy and half an hour after cardiac reperfusion in both groups.
(1) The numbers of polymorphonuclear (PMN) of the two groups were increased significantly after cardiopulmonary bypass (P < 0.01). (2) The number of PMN and SOD, PaO2 contents were significantly higher in Group IP than in Group C (P < 0.05). (3) The numbers of PMN in lung interstitum under microscopy were less in Group IP than in Group C. (4) MDA contents were less in Group IP than in Group C (P < 0.05). (5) Histological finding showed less damage in Group IP than in Group C. It is evident that cardiac ischemic preconditioning could protect lung against ischemia reperfusion injury. The possible mechanisms are that ischemic preconditioning inhibites the accumulation and activation of PMN in lung tissue and reduces the production of oxygen free radicals.
20例直视心内手术患者随机分为两组。体外循环后,10例患者接受心肌缺血预处理。主动脉阻断3分钟,松开3分钟(预处理组)。另外10例患者未进行缺血预处理(对照组),仅接受6分钟体外循环。然后阻断主动脉并进行心内手术。两组均在开胸后及心脏再灌注半小时后采集左心房血液和肺组织。
(1)两组体外循环后多形核白细胞(PMN)数量均显著增加(P<0.01)。(2)预处理组PMN数量、超氧化物歧化酶(SOD)及动脉血氧分压(PaO2)含量均显著高于对照组(P<0.05)。(3)显微镜下预处理组肺间质PMN数量少于对照组。(4)预处理组丙二醛(MDA)含量低于对照组(P<0.05)。(5)组织学检查显示预处理组损伤小于对照组。显然,心脏缺血预处理可保护肺组织免受缺血再灌注损伤。可能的机制是缺血预处理抑制肺组织中PMN的聚集和激活,并减少氧自由基的产生。