Department of Cardiothoracic Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, PR China.
J Surg Res. 2010 Nov;164(1):e21-6. doi: 10.1016/j.jss.2010.06.016. Epub 2010 Jul 2.
Remote perconditioning has been proved to reduce myocardial infarction and improve ventricular function in vivo. This study aims to determine the protection of remote perconditioning against cardiac reperfusion injury in patients undergoing valve replacement.
Eighty-one patients admitted for selective valve replacement were divided into three groups randomly. Control patients (con. n = 27) underwent sham placement of the tourniquet around the right thigh without inflation; the remote preconditioning group (pre. n = 26) received three cycles of 4/4 min right lower limb ischemia and reperfusion after induction of anesthesia, the limb ischemia was induced by the tourniquet inflated to 600 mmHg; the remote perconditioning group (per. n = 28) received the same stimulus immediately after aortic cross-clamping. Venous blood samples were obtained preoperatively, 5 min before declamping, 30 min, 4, 12, and 72 h after declamping for detecting troponin I (cTnI) concentration. The clinical data of inotrope requirement, drainage, ventilation. and intensive care time were routinely recorded.
The remote perconditioning group had significantly lower release of cTnI 5 min before declamping (con. versus pre. versus per., 0.15 ± 0.10 versus 0.13 ± 0.08 versus 0.10 ± 0.04 ng/mL, P = 0.050) and 30 min after declamping (con. versus pre. versus per., 0.40 ± 0.24 versus 0.41 ± 0.40 versus 0.24 ± 0.13 ng/mL, P = 0.043). Less incidence of defibrillation were observed in the remote perconditioning groups.
Remote perconditioning, which is induced by transient lower limb ischemia after aortic cross-clamping, reduces myocardial injury over cardioplegia in adults undergoing selective valve replacement.
远程预处理已被证明可减少体内心肌梗死并改善心室功能。本研究旨在确定在接受瓣膜置换术的患者中，远程预处理对心脏再灌注损伤的保护作用。
81 名因选择性瓣膜置换术而入院的患者被随机分为三组。对照组（con.，n = 27）在诱导麻醉后，将止血带环绕大腿假放置而不充气；远程预处理组（pre.，n = 26）在麻醉诱导后接受三次右下肢缺血和再灌注循环，每次 4/4 分钟，肢体缺血通过充气至 600mmHg 的止血带引起；远程后处理组（per.，n = 28）在主动脉阻断后立即接受相同的刺激。术前、阻断前 5 分钟、阻断后 30 分钟、4 小时、12 小时和 72 小时采集静脉血样，以检测肌钙蛋白 I（cTnI）浓度。常规记录正性肌力药需求、引流、通气和重症监护时间等临床数据。
远程后处理组在阻断前 5 分钟（con. 与 pre. 与 per.，0.15 ± 0.10 与 0.13 ± 0.08 与 0.10 ± 0.04ng/mL，P = 0.050）和阻断后 30 分钟（con. 与 pre. 与 per.，0.40 ± 0.24 与 0.41 ± 0.40 与 0.24 ± 0.13ng/mL，P = 0.043）时 cTnI 的释放明显较低。远程后处理组的除颤发生率较低。
在主动脉阻断后短暂的下肢缺血后诱导的远程后处理可减少成人选择性瓣膜置换术中心脏停搏时的心肌损伤。
