幼龄犬胸腔镜体外循环术中抑肽酶的心肌保护作用

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1、幼龄犬胸腔镜体外循环术中抑肽酶的心肌保护作用作者：陈涛，魏旭峰，易定华，徐学增，杨剑，俞世强【摘要】目的观察幼龄犬胸腔镜体外循环术中、术后心肌损伤情况，以及探讨抑肽酶的心肌保护作用。方法20只幼龄犬，体重10～15kg，随机分成两组，每组10只，采用经股动脉、股静脉插管后建立体外循环，对照组(A组)不加入抑肽酶；实验组(B组)于转机过程加入抑肽酶4～5万KIU／kg。两组均于麻醉诱导后、主动脉阻断后10min、30min、主动脉开放后30min，停机后2h、12h抽取桡动脉血测定两组血清中CKMB、cTnI、TN

2、F-α、IL-8、IL-10含量。结果两组CKMB、cTnI、TNF-α、IL-8、IL-10主动脉阻断前无明显差别(P>0.05)；A组在主动脉阻断后均逐渐升高(P<0.05)，在停机后2h达高峰，停机后12h下降，而cTnI持续未见下降；B组与A组相比较除IL-10含量各时间点明显升高外其余均较低，具有统计学意义(P<0.05)，B组cTnI含量在停机后2h后出现下降，与A组比较具有显著差异性(P<0.05)。结论幼龄犬胸腔镜体外循环术后的心肌损伤程度可能以停机后2h最明显，后未再出现

3、持续性加重。抑肽酶能减轻幼龄犬胸腔镜体外循环术后炎性反应，具有良好的心肌保护作用。【关键词】胸腔镜；体外循环；心肌损伤；细胞因子；抑肽酶10　　MyocardialProtectiveEffectofAprotinininPuppies'ExtracorporealCirculationCardiacSurgerywithThoracoscope　　Abstract:OBJECTIVEToobservethestateofmyocardialdamageandstudythemyocardialprotectiv

4、eeffectofaprotininafterextracorporealcirculationofvideo-assistedthoracoscopeoperationonpuppies．METHODSTwentypuppieswithweightfrom10to15kgwererandomlydividedinto2groupsaccordingtowhetherusingaprotinin(GroupB)ornot(GroupA)duringextracorporealcirculation(ECC).EC

5、Cwassetupbytherightfemoralarteryandfemoralvenous．Theradialarterialbloodsampleswerecollectedatthefollowingtimepoints：afterinductionofanesthesia，10minand30minafteraorticclamping,30minafteraorticopening,2hand12hafterECC.ThecardiactroponinI(cTnI),MBisoenzymeofcre

6、atinekinase(CKMB),interleukin-8(IL-8),tumornecrosisfactor-α(TNF-α)andinterleukin-10(IL-10)weremeasured.RESULTSTherewerenosignificantdifferencesbetweentwogroupsonthelevelsofCKMB,cTnI,TNF-α,IL-8andIL-10beforeaorticclamping(P>0.05).TheconcentrationofCKMB,cTnI

7、,TNF-αandIL-8graduallyraised(P<0.05)andarrivedtothehighestleveltwohoursafterECCingroupAandthenfell．Whilethe10persistenceofcTnIbehavedotherwise,maintainingahighlevel.ButAllabovementionedafteraorticclampingweresignificantlyhigherthanthatafterinductionofanest

8、hesia.ThelevelofCKMB,cTnI,TNF-αandIL-8ingroupBwerelowerthanthatofgroupAafteraorticclamping(P<0.05),butIL-10ingroupBwasremarkablyhigher(P<0.05).ThelevelofcTnIdeclinedat2hafterECCingr