Department of Anesthesiology, Xijing Hospital, Fourth Military Medical University, Xi'an, China.
Ann Thorac Surg. 2010 Mar;89(3):781-6. doi: 10.1016/j.athoracsur.2009.12.003.
Cardiac ischemia-reperfusion injury after cardiopulmonary bypass contributes to postoperative morbidity and mortality in patients with open-heart surgery. This randomized controlled trial was designed to address the protective effects of electroacupuncture (EA) pretreatment on myocardial injury in patients undergoing heart valve replacement surgery.
Sixty patients with acquired heart valve disease were randomly allocated to the EA pretreatment group or the control group. Patients in the EA group received EA stimulus at bilateral Neiguan (PC 6), Lieque (LU 7), and Yunmen (LU 2) for 30 minutes each day for five consecutive days before surgery. Hemodynamic data, mechanical ventilation time, inotropic drug use in the intensive care unit, serum cardiac troponin I concentrations, morbidities, and mortalities were compared between the two groups. This trial is registered with ClinicalTrials.gov, number NCT00732459.
At 6 hours, 12 hours, and 24 hours after reperfusion, levels of serum cardiac troponin I were significantly decreased in the EA group (5.74 +/- 0.67, 6.22 +/- 0.66, and 5.21 +/- 0.58) compared with that in the control group (7.89 +/- 0.74, 8.34 +/- 1.08, and 7.57 +/- 0.89, p < 0.05). The EA pretreatment significantly reduced overall serum troponin I release at 6 hours, 12 hours, and 24 hours after aortic cross-clamp removal. Meanwhile, EA pretreatment also reduced the inotrope score at 12 hours, 24 hours, and 48 hours after the intensive care unit arrival and shortened intensive care unit stay time (p < 0.05).
The present study demonstrated that EA pretreatment may alleviate cardiac ischemia-reperfusion injury in adult patients undergoing heart valve replacements. This simple and convenient treatment has the potential to be used in the clinic for reducing myocardial injury in patients with heart valve replacement surgery.
体外循环后的心脏缺血再灌注损伤导致心脏直视手术后患者的发病率和死亡率增加。这项随机对照试验旨在探讨电针预处理对心脏瓣膜置换术患者心肌损伤的保护作用。
将 60 例获得性心脏瓣膜病患者随机分为电针预处理组和对照组。电针预处理组患者在术前 5 天每天接受双侧内关（PC6）、列缺（LU7）和云门（LU2）电刺激 30 分钟。比较两组患者的血流动力学数据、机械通气时间、重症监护室使用正性肌力药物、血清心肌肌钙蛋白 I 浓度、发病率和死亡率。本试验已在 ClinicalTrials.gov 注册，编号为 NCT00732459。
再灌注后 6 小时、12 小时和 24 小时，电针预处理组血清心肌肌钙蛋白 I 水平（5.74±0.67、6.22±0.66 和 5.21±0.58）明显低于对照组（7.89±0.74、8.34±1.08 和 7.57±0.89，p<0.05）。电针预处理组主动脉阻断后 6 小时、12 小时和 24 小时总血清肌钙蛋白 I 释放明显减少。同时，电针预处理组在 ICU 到达后 12 小时、24 小时和 48 小时的正性肌力评分也降低，入住 ICU 时间缩短（p<0.05）。
本研究表明，电针预处理可能减轻成人心脏瓣膜置换术患者的心脏缺血再灌注损伤。这种简单方便的治疗方法有可能在临床上用于减少心脏瓣膜置换术患者的心肌损伤。
