尼可地尔对心脏瓣膜置换术患者心肌缺血再灌注损伤的保护作用

中国临床药理学与治疗学 ›› 2010, Vol. 15 ›› Issue (3): 322-325.

尼可地尔对心脏瓣膜置换术患者心肌缺血再灌注损伤的保护作用

刘流, 周海洋, 王建斌, 吕志平

中南大学湘雅二医院麻醉科,长沙 410011,湖南

收稿日期:2010-01-04 修回日期:2010-03-04 发布日期:2020-10-14
通讯作者: 周海洋,男,博士,主治医师,主要从事体外循环术中心肌保护研究。Tel: 13637417518 E-mail: norcuron@163.com
作者简介:刘流,男,副教授,主要从事体外循环术中心肌保护研究。Tel: 13723887728 E-mail: Liuliucs06@126.com
基金资助:
湖南省科学技术基金项目(2009JT3018)

Protective effect of nicorandil on myocardial ischemia reperfusion injury in patients undergoing cardiac valve replacement

LIU Liu, ZHOU Hai-yang, WANG Jian-bin, LU Zhi-ping

Department of Anesthesiology, Xiangya Second Hospital,Central South University,Changsha 410011,Hunan,China

Received:2010-01-04 Revised:2010-03-04 Published:2020-10-14

摘要/Abstract

摘要： 目的: 观察尼可地尔对心脏瓣膜置换术患者心肌缺血再灌损伤的保护作用。方法: 60例心脏瓣膜置换术患者分为对照组(Ⅰ组)、尼可地尔延迟处理组(Ⅱ组)、尼可地尔早期处理组(Ⅲ组),每组20例。Ⅱ组在术前 24 h 用尼可地尔 20 mg 静滴。Ⅲ组在麻醉诱导后用尼可地尔 20 mg 静滴。在阻断主动脉即刻(T₀)、开放主动脉 15 min(T₁)、30 min(T₂)、60 min(T₃)、90 min(T₄)取冠状静脉窦血测定心肌肌钙蛋白(cTnI)、TNF-α、IL-6,并记录心脏复跳方式和心脏复跳后的心律失常发生率。在阻断主动脉即刻和开放主动脉后 30 min 取右房肌肉组织行电镜观察。结果: Ⅱ、Ⅲ组cTnI、TNF-α、IL-6含量明显低于Ⅰ组,电镜下心肌超微结构受损程度小于Ⅰ组。Ⅱ组患者在T₃、T₄时刻与Ⅲ组患者同时值比较:cTnI、TNF-α、IL-6含量降低,心肌超微结构受损程度小于Ⅲ组。结论: 尼可地尔可明显减轻心脏瓣膜置换术患者心肌缺血再灌注损伤,延迟处理方式的保护作用优于早期处理方式。

关键词: 尼可地尔, 心脏瓣膜置换, 心肌保护

Abstract: AIM: To observe the protective effect of nicorandil on myocardial ischemia reperfusion injury in patients undergoing valve replacement. METHODS: Sixty patients undergoing valve repalacement were randomly divided into 3 groups: control(Ⅰ) group, nicorandil delayed precondictioning(Ⅱ) group and nicorandil preconditioning(Ⅲ) group. 20 mg nicorandil was given i.v. 24 h before operation in group Ⅱ, whereas in group Ⅲ, 20 mg nicorandil was given i.v. after induction of anesthesia. Blood samples were taken from coronary venous for determination of cTnI, TNF-α, IL-6 levels at aortic clamping (T₀), 15 min (T₁), 30 min(T₂), 60 min (T₃), 90 min(T₄) after aortic declamping. Right atria myocardium tissue were taken at T₀ and T₂ to observe the histopathological changes with electron microscopy. RESULTS: The levels of cTnI, TNF-αand IL-6 in group Ⅱand Ⅲ were significantly lower than those in group I. Myocardium injury was obviously lighter in groupⅡand Ⅲ than that in group Ⅰ, whereas the levels of cTnI, TNF-α, IL-6 and myocardium injury were lower in group Ⅱ than those in group Ⅲ. CONCLUSION: Nicorandil is effcetive in decreasing myocardial ischemia repefusion injury in patients undergoing valve replacement, The protective effect of nicorandil delayed preconditioning is more obvious than precondictioning.

Key words: Nicorandil, Heart valve replacement, Implantation, Myocardial protection

中图分类号:

R614

刘流, 周海洋, 王建斌, 吕志平. 尼可地尔对心脏瓣膜置换术患者心肌缺血再灌注损伤的保护作用[J]. 中国临床药理学与治疗学, 2010, 15(3): 322-325.

LIU Liu, ZHOU Hai-yang, WANG Jian-bin, LU Zhi-ping. Protective effect of nicorandil on myocardial ischemia reperfusion injury in patients undergoing cardiac valve replacement[J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2010, 15(3): 322-325.

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