Ji Qiang, Mei Yunqing, Wang Xisheng, Feng Jing, Wusha Dewei, Cai Jianzhi, Zhou Yongxin
Department of Thoracic Cardiovascular Surgery, Tongji Hospital, Shanghai, PR China.
Int Heart J. 2011;52(5):312-7. doi: 10.1536/ihj.52.312.
Inappropriate myocardial protection is considered one of the main causes of mortality and morbidity in the correction of tetralogy of Fallot (TOF). Results of previous reports about the effects of ischemic postconditioning on myocardial protection in animals and humans are very encouraging. This randomized and controlled trial aimed to assess the effect of ischemic postconditioning on protection against myocardial ischemia reperfusion injury in TOF patients receiving cardioplegia. From January 2008 to June 2010, 80 consecutive children undergoing correction of TOF were enrolled and randomly assigned to either a postconditioning group (three cycles of 30 seconds of ischemia and 30 seconds of reperfusion using re-clamping and de-clamping starting 30 seconds after the initial de-clamping of the aorta, n = 41) or a control group (n = 39). Cardiac troponin I (cTnI) was assayed preoperatively, and then 4 hours, 8 hours, 12 hours, 20 hours, and 48 hours after persistent reperfusion. The pre-, intra- and postoperative relevant data of all selected patients were analyzed. As a result, ischemic postconditioning reduced postoperative peak release by 45% for cTnI compared with the control group (0.43 ± 0.18 ng/mL versus 0.78 ± 0.15 ng/mL, P < 0.0001). Ischemic postconditioned patients had a lower peak inotropic score during the first postoperative 24 hours (5.6 ± 2.2 µg/kg/minute versus 8.6 ± 3.6 µg/kg/minute, P < 0.0001), extubation time (21.5 ± 7.3 hours versus 30.2 ± 12.4 hours, P = 0.0002) and length of ICU stay (43.4 ± 12.6 hours versus 56.3 ± 17.8 hours, P = 0.0003), while they had a higher cardiac output on the first postoperative day (1.41 ± 0.26 L/minute versus 1.28 ± 0.25 L/minute, P = 0.0255) as compared to the control group. In conclusion, ischemic postconditioning may to some extent provide myocardial protection in children undergoing correction of tetralogy of Fallot.
不适当的心肌保护被认为是法洛四联症（TOF）矫治术中死亡率和发病率的主要原因之一。先前有关缺血后处理对动物和人类心肌保护作用的报道结果非常令人鼓舞。这项随机对照试验旨在评估缺血后处理对接受心脏停搏液的TOF患者心肌缺血再灌注损伤的保护作用。2008年1月至2010年6月，连续纳入80例接受TOF矫治术的儿童，并随机分为后处理组（在主动脉首次松开夹闭30秒后，进行三个周期的30秒缺血和30秒再灌注，通过重新夹闭和松开夹闭实现，n = 41）或对照组（n = 39）。术前以及持续再灌注后4小时、8小时、12小时、20小时和48小时检测心肌肌钙蛋白I（cTnI）。对所有入选患者的术前、术中和术后相关数据进行分析。结果显示，与对照组相比，缺血后处理使cTnI术后峰值释放降低了45%（0.43±0.18 ng/mL对0.78±0.15 ng/mL，P < 0.0001）。缺血后处理组患者术后24小时内的峰值变力评分较低（5.6±2.2 μg/kg/分钟对8.6±3.6 μg/kg/分钟，P < 0.0001），拔管时间较短（21.5±7.3小时对30.2±12.4小时，P = 0.0002），重症监护病房（ICU）住院时间较短（43.4±12.6小时对56.3±17.8小时，P = 0.0003），而术后第一天的心输出量较高（1.41±0.26 L/分钟对1.28±0.25 L/分钟，P = 0.0255）。总之，缺血后处理在一定程度上可能为接受法洛四联症矫治术的儿童提供心肌保护。
