Luo Wanjun, Zhu Ming, Huang Rimao, Zhang Yangde
Department of Cardiothoracic Surgery, Xiang Ya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, People's Republic of China.
Cardiol Young. 2011 Jun;21(3):266-70. doi: 10.1017/S1047951110001915. Epub 2011 Jan 25.
Remote ischaemic pre-conditioning and cardiac ischaemic post-conditioning provide myocardial protection in cardiac surgery. However, these two endogenous strategies have not been directly compared in a clinical setting. The purpose of this study was to compare the efficacy of remote ischaemic pre-conditioning and post-conditioning in providing myocardial protection to children undergoing cardiopulmonary bypass for surgical repair of ventricular septal defect.
We randomly assigned 60 paediatric patients scheduled for surgical correction of congenital ventricular septal defect to the post-conditioning group (n = 20), remote pre-conditioning group (n = 20), or control group (n = 20). Post-conditioning consisted of 30 seconds of ischaemia and 30 seconds of reperfusion achieved by clamping and unclamping the aorta, repeated three times over 3 minutes immediately after cardioplegic arrest. Remote ischaemic pre-conditioning consisted of 5 minutes of lower limb ischaemia followed by 5 minutes of reperfusion using a blood-pressure cuff inflated to a pressure of 200 millimetres of mercury, also repeated three times over 30 minutes. We assayed creatine kinase-MB, troponin I.
Mean age, cardiopulmonary bypass times, and aortic cross-clamp times were matched across groups. Both post-conditioning and remote ischaemic pre-conditioning reduced the peak release of creatine kinase-MB (86.1 plus or minus 24.1 units per litre and 92.8 plus or minus 20.6 units per litre, respectively, versus 111.0 plus or minus 44.6 units per litre in the control, p less than 0.05) and troponin I (0.28 plus or minus 0.10 nanogram per millilitre and 0.26 plus or minus 0.09 nanogram per millilitre, respectively, versus 0.49 plus or minus 0.19 nanogram per millilitre in the control group, p less than 0.05).
Our study demonstrates that ischaemic post-conditioning and remote ischaemic pre-conditioning provide comparable myocardial benefit in children undergoing cold blood cardioplegic arrest.
远程缺血预处理和心脏缺血后处理可在心脏手术中提供心肌保护。然而，这两种内源性策略尚未在临床环境中进行直接比较。本研究的目的是比较远程缺血预处理和后处理在为接受体外循环进行室间隔缺损手术修复的儿童提供心肌保护方面的效果。
我们将60例计划进行先天性室间隔缺损手术矫正的儿科患者随机分为后处理组（n = 20）、远程预处理组（n = 20）或对照组（n = 20）。后处理包括在心脏停搏后立即通过夹闭和松开主动脉实现30秒缺血和30秒再灌注，在3分钟内重复3次。远程缺血预处理包括使用血压袖带将压力充至200毫米汞柱进行5分钟下肢缺血，随后进行5分钟再灌注，同样在30分钟内重复3次。我们检测了肌酸激酶-MB、肌钙蛋白I。
各组的平均年龄、体外循环时间和主动脉阻断时间相匹配。后处理和远程缺血预处理均降低了肌酸激酶-MB的峰值释放（分别为86.1±24.1单位/升和92.8±20.6单位/升，而对照组为111.0±44.6单位/升，p<0.05）和肌钙蛋白I（分别为0.28±0.10纳克/毫升和0.26±0.09纳克/毫升，而对照组为0.49±0.19纳克/毫升，p<0.05）。
我们的研究表明，缺血后处理和远程缺血预处理在接受冷血心脏停搏的儿童中提供了相当的心肌益处。
