重组人促红细胞生成素预处理对体外循环手术中心肌的保护作用

摘要

目的：探讨重组人促红细胞生成素（rHuEPO）预处理对体外循环（CPB）手术中心肌的保护作用、机制及安全性。方法选择30例拟行瓣膜置换术的风湿性心脏病患者，将其分为观察组和对照组，观察组术前2 d给予皮下注射 rHuEPO 300 IU/kg ，1次/天，共2 d；对照组给予等量生理盐水。检测术前及术后第7天血常规，以及术前、主动脉开放后6、24、72 h血清肌酸激酶同工酶（CK-MB）、肌钙蛋白T（cTnT）水平。术毕心肌活检，检测心肌细胞凋亡指数。记录CPB时间、主动脉阻断（ACC）时间、ICU停留时间、输血及术后并发症情况。结果两组患者术后CK-MB、cTnT 均于主动脉开放后显著升高，术后6 h数值最高，其后呈下降趋势。术后各时点观察组CK-MB、cTnT水平均低于对照组，rHuEPO处理主效应两组间差异有统计学意义（P＝0．01）。心肌细胞凋亡指数观察组明显低于对照组，差异有统计学意义（P＜0．01）。观察组没有导致术后血红蛋白（Hb）、血细胞比容（Hct）明显升高和增加血栓栓塞的风险，并减少术后输血量。结论 rHuEPO预处理对CPB手术中的心肌具有保护作用，可减少心肌细胞凋亡，具有安全可靠性。%Objective To investigate the myocardial protective effects ,mechanism and safety of recombinant human erythropoie-tin(rHuEPO) pretreatment in the patients undergoing cardiac surgery with cardiopulmonary bypass (CPB) .Methods Thirty pa-tients with rheumatic heart disease undergoing valve replacement surgery were randomly divided into the observation group and the control group ,15 cases in each group .The observation group was given rHuEPO 300IU/kg by hypodermic injection on preoperative 2 d ,once daily for twice .The control group was given the same dose of normal saline .The blood routine was performed before sur-geryandonpostoperative7d.Thelevelsofcreatinekinaseisoenzyme(CK-MB)andtroponinT(cTnT)weredetectedbeforeopera-tion ,at 6 ,24 ,72 h after the aorta opening (T0 ,T6 ,T24 ,T72 ) .At the end of CPB ,myocardial biopsy was conducted for detecting the myocardial apoptosis index (AI) .The CPB time ,aortic cross clamp(ACC) time ,postoperative ICU stay ,blood transfusion and post-operative complications were recorded .Results The level of postoperative CK-MB and cTnT in the two groups were significantly increased after the aorta opening ,which at T6 was highest ,followed by a downward trend .The levels of CK-MB and cTnT at vari-ous time points in the observation group were significantly lower than those in the control group .The main effect of rHuEPO pre-treatment had statistical difference between the two groups (P= 0 .01) .Myocardial AI in the observation group was significantly lower than that in the control group ,the difference showing statistical significance (P<0 .01) .The observation group had no risk leading to obviously increase postoperative Hb ,Hct values and thromboembolism ,but the postoperative blood transfusion amount was reduced .Conclusion rHuEPO pretreatment has the protective effect on myocardium in the patients undergoing cardiac surgery under CPB ,which can reduce myocardial apoptosis and has safe reliability .