体外循环下心内直视手术患儿的晚期远程缺血预处理：一项随机对照试验。
Late remote ischemic preconditioning in children undergoing cardiopulmonary bypass: a randomized controlled trial.
机构信息
Division of Pediatric Critical Care Medicine, Hospital das Clínicas, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil.
出版信息
J Thorac Cardiovasc Surg. 2012 Jul;144(1):178-83. doi: 10.1016/j.jtcvs.2011.12.029. Epub 2012 Jan 12.
OBJECTIVE
Cardiopulmonary bypass is associated with ischemia-reperfusion injury to multiple organs. We aimed to evaluate whether remote ischemic preconditioning performed the day before surgery for congenital heart disease with cardiopulmonary bypass attenuates the postoperative inflammatory response and myocardial dysfunction.
METHODS
This was a prospective, randomized, single-blind, controlled trial. Children allocated to remote ischemic preconditioning underwent 4 periods of 5 minutes of lower limb ischemia by a blood pressure cuff intercalated with 5 minutes of reperfusion. Blood samples were collected 4, 12, 24, and 48 hours after cardiopulmonary bypass to evaluate nuclear factor kappa B activation in leukocytes by quantification of mRNA of I kappa B alpha by real-time quantitative polymerase chain reaction and for interleukin-8 and 10 plasma concentration measurements by enzyme-linked immunosorbent assay. Myocardial dysfunction was assessed by N-terminal pro-B-type natriuretic peptide and cardiac troponin I plasma concentrations, measured by chemiluminescence, and clinical parameters of low cardiac output syndrome.
RESULTS
Twelve children were allocated to remote ischemic preconditioning, and 10 children were allocated to the control group. Demographic data and Risk Adjustment for Congenital Heart Surgery 1 classification were comparable in both groups. Remote ischemic preconditioning group had lower postoperative values of N-terminal pro-B-type natriuretic peptide, but cardiac troponin I levels were not significantly different between groups. Interleukin-8 and 10 concentrations and I kappa B alpha gene expression were similar in both groups. Postoperative morbidity was similar in both groups; there were no postoperative deaths in either group.
CONCLUSIONS
Late remote ischemic preconditioning did not provide clinically relevant cardioprotection to children undergoing cardiopulmonary bypass.
目的
体外循环可导致多个器官发生缺血再灌注损伤。本研究旨在评估体外循环先天性心脏病手术前一天进行的远程缺血预处理是否能减轻术后炎症反应和心肌功能障碍。
方法
这是一项前瞻性、随机、单盲、对照试验。远程缺血预处理组患者通过血压袖带进行 4 个 5 分钟的下肢缺血，然后再进行 5 分钟的再灌注，从而进行 4 次肢体缺血预处理。在体外循环后 4、12、24 和 48 小时采集血样，通过实时定量聚合酶链反应测定白细胞核因子 κB 激活的 IκBα mRNA 量，用酶联免疫吸附法测定白细胞介素 8 和 10 的血浆浓度，从而评估核因子 κB 的激活情况。通过化学发光法测定 N 末端脑钠肽前体和心肌肌钙蛋白 I 的血浆浓度，评估心肌功能障碍，并结合临床低心排血量综合征的参数进行评估。
结果
12 例患者被分配到远程缺血预处理组，10 例患者被分配到对照组。两组患者的人口统计学数据和先天性心脏病手术风险调整 1 分类无差异。远程缺血预处理组术后 N 末端脑钠肽前体的水平较低，但两组间心肌肌钙蛋白 I 的水平无显著差异。两组间白细胞介素 8 和 10 的浓度和 IκBα 基因表达相似。两组术后发病率相似，两组均无术后死亡。
结论
晚期远程缺血预处理不能为接受体外循环的儿童提供有临床意义的心肌保护。
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