高氧液预处理对心脏瓣膜置换术患者血浆丙二醛和超氧化物歧化酶的影响

目的观察高氧液预处理对心脏瓣膜置换术患者血浆丙二醛(MDA)和超氧化物歧化酶(SOD)的影响。方法30例择期心脏瓣膜置换术患者随机分为试验组和对照组,在麻醉后切皮前(T0)至心肺转流(CPB)开始后10 min,对照组静滴复方氯化钠注射液10 mL/kg,试验组给予相等容量的高氧液。分别于麻醉后切皮前(T0)、CPB开始后1 h(T1)、主动脉开放后2 h(T2)、主动脉开放后24 h(T3)共4个时点,测定MDA和SOD。结果T0时点MDA质量浓度两组间无明显差异(P>0.05),T1时显著增高,T2时达高峰,T3仍显著高于术前(P<0.05)。两组间比较,T2时试验组明显低于对照组(P<0.01)。T0时点SOD活性两组间无明显差异(P>0.05),试验组各时点无明显变化(P>0.05)。对照组T1、T2时明显降低,与试验组相比有明显差异(P<0.05)。两组心脏自动复跳率、电除颤率、心律失常发生率、术中多巴胺用量相比均无明显差异(P>0.05),术后24 h多巴胺用量,试验组明显低于对照组(P<0.01)。结论高氧液预处理能使MDA质量浓度明显下降,SOD活性保持不变,减轻心肌缺血/再灌注损伤。

Effect of hyperoxia liquid preconditioning on malondialdehyde and super oxide dismutase during valve replacement with cardiopulmonary bypass

Objective To observe the cardioprotective effects of hyperoxia liquid by comparing the changes of blood concentrations of malondialdehyde(MDA)and super oxide dismutase(SOD)in mechanical heart valve replacement.Methods Thirty patients required mechanical heart valve replacement were randomly divided into hyperoxia liquid group(Group HL) and control group 15 cases in each.From the start of skin incision(T_(0)) to(10min) after CPB,patients received 10mL/kg Ringer's injection(control group) and 10mL/kg hyperoxia liquid(Group HL) seperately.The central venous blood samples,which were collected in both groups respectively at skin incision(T_(0)),1h after start of CPB(T_1),2h(T_2) and 24h(T_3) after aorta off-clamping,were used to test the blood concentrations of SOD and MDA.Also a series of clinical data were recorded,such as the rate of heart automatic rebeat after aorta off-clamping,ventricular arrhythmia,usage of dopamine in operation and postoperation.(Results)In both groups,the blood concentrations of MDA and SOD were all within normal range before operation.MDA level at T_(2) was lower in Group HL than that in control(P<0.05).As compared with Group HL,a significant decrease of SOD in control group was noted at T_(2) and T_(3)(P<0.05).The rate of spontaneously rebeating of the hearts in two groups were similar after reperfusion,usage of dopamine in control group was higher than that in Group HL 24h after aorta off-clamping(P<0.01).Conclusion Hyperoxia liquid preconditioning,as an endogenous myocardial protective measure,has better myocardial protection effects.