远程缺血预处理可减轻接受冷血心脏停搏液心脏手术患者的心肌损伤：一项随机对照试验。
Remote ischaemic preconditioning reduces myocardial injury in patients undergoing cardiac surgery with cold-blood cardioplegia: a randomised controlled trial.
作者信息
Venugopal V, Hausenloy D J, Ludman A, Di Salvo C, Kolvekar S, Yap J, Lawrence D, Bognolo J, Yellon D M
机构信息
The Hatter Cardiovascular Institute, University College London Hospital, 67 Chenies Mews, London WC1E 6HX, UK.
出版信息
Heart. 2009 Oct;95(19):1567-71. doi: 10.1136/hrt.2008.155770. Epub 2009 Jun 8.
BACKGROUND
Remote ischaemic preconditioning (RIPC) induced by brief ischaemia and reperfusion of the arm reduces myocardial injury in coronary artery bypass (CABG) surgery patients receiving predominantly cross-clamp fibrillation for myocardial protection. However, cold-blood cardioplegia is the more commonly used method world wide.
OBJECTIVE
To assess whether RIPC is cardioprotective in CABG patients receiving cold-blood cardioplegia.
DESIGN
Single-centre, single-blinded, randomised controlled trial.
SETTING
Tertiary referral hospital in London.
PATIENTS
Adults patients (18-80 years) undergoing elective CABG surgery with or without concomitant aortic valve surgery with cold-blood cardioplegia. Patients with diabetes, renal failure (serum creatinine >130 mmol/l), hepatic or pulmonary disease, unstable angina or myocardial infarction within the past 4 weeks were excluded.
INTERVENTIONS
Patients were randomised to receive either RIPC (n = 23) or control (n = 22) after anaesthesia. RIPC comprised three 5 min cycles of right forearm ischaemia, induced by inflating a blood pressure cuff on the upper arm to 200 mm Hg, with an intervening 5 min reperfusion. The control group had a deflated cuff placed on the upper arm for 30 min.
MAIN OUTCOME MEASURES
Serum troponin T was measured preoperatively and at 6, 12, 24, 48 and 72 h after surgery and the area under the curve (AUC at 72 h) calculated.
RESULTS
RIPC reduced absolute serum troponin T release by 42.4% (mean (SD) AUC at 72 h: 31.53 (24.04) microg/l.72 h in controls vs 18.16 (6.67) microg/l.72 h in RIPC; 95% CI 2.4 to 24.3; p = 0.019).
CONCLUSIONS
Remote ischaemic preconditioning induced by brief ischaemia and reperfusion of the arm reduces myocardial injury in CABG surgery patients undergoing cold-blood cardioplegia, making this non-invasive cardioprotective technique widely applicable clinically.
TRIAL REGISTRATION NUMBER
NCT00397163.
背景
通过短暂缺血和再灌注手臂诱导的远程缺血预处理（RIPC）可减少在冠状动脉搭桥术（CABG）中主要采用交叉夹闭颤动进行心肌保护的患者的心肌损伤。然而，冷血心脏停搏液是全球更常用的方法。
目的
评估RIPC对接受冷血心脏停搏液的CABG患者是否具有心脏保护作用。
设计
单中心、单盲、随机对照试验。
地点
伦敦的一家三级转诊医院。
患者
接受择期CABG手术（无论是否同时进行主动脉瓣手术）并使用冷血心脏停搏液的成年患者（18 - 80岁）。排除患有糖尿病、肾衰竭（血清肌酐>130 mmol/l）、肝或肺疾病、不稳定型心绞痛或在过去4周内发生心肌梗死的患者。
干预措施
患者在麻醉后随机分为接受RIPC组（n = 23）或对照组（n = 22）。RIPC包括三个5分钟的右前臂缺血周期，通过将上臂的血压袖带充气至200 mmHg诱导，中间间隔5分钟再灌注。对照组在上臂放置一个放气的袖带30分钟。
主要观察指标
术前以及术后6、12、24、48和72小时测量血清肌钙蛋白T，并计算曲线下面积（72小时的AUC）。
结果
RIPC使血清肌钙蛋白T的绝对释放量降低了42.4%（72小时的平均（标准差）AUC：对照组为31.53（24.04）μg/l·72小时，RIPC组为18.16（6.67）μg/l·72小时；95%可信区间为2.4至24.3；p = 0.019）。
结论
通过短暂缺血和再灌注手臂诱导的远程缺血预处理可减少接受冷血心脏停搏液的CABG手术患者的心肌损伤，使这种非侵入性心脏保护技术在临床上具有广泛的适用性。
试验注册号
NCT00397163。
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