Role of ozonated autohemotransfusion in improving myocardial injury of patients with coronary artery abnormality after non-cardiac surgery
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摘要:目的 探讨三氧自体血回输对冠状动脉病变患者非心脏手术后心肌损伤的影响。方法 选取择期行胃癌、肠癌、食管癌根治术患者90例，随机分为三氧治疗组(n=45)和对照组(n=45)。三氧治疗组于手术当天及术后第1、2天行三氧自体血回输治疗，对照组仅行自体血回输。于麻醉前(T0)、术后6 h(T1)、术后12 h(T2)、术后24 h(T3)、术后48 h(T4)抽取静脉血，检测血浆中心肌肌钙蛋白I(cTnI)、心肌肌钙蛋白T(cTnT)含量。采用经胸超声测量三尖瓣前叶瓣环的移位(TAPSE)及左室射血分数(LVEF)。记录术后24 h血管活性药物分数(VIS)、C反应蛋白(CRP)、白细胞介素-6(IL-6)和术中时间加权平均动脉压(TWA-MAP)。结果 2组患者术后的cTnI、cTnT均有不同程度升高，与对照组比较，三氧治疗组T2、T3、T4时cTnI及cTnT表达减少，差异有统计学意义(P < 0.05)。与对照组相比，三氧治疗组LVEF和TAPSE在T1、T2、T3时均增加，且术后24 h的VIS分数降低，差异有统计学意义(P < 0.05)。与对照组相比，三氧治疗组患者术后24 h的CRP及IL-6降低，差异有统计学意义(P < 0.05)。结论 三氧自体血回输可改善冠状动脉病变患者非心脏手术后的心肌损伤。Abstract:Objective To explore the effect of ozonated autohemotransfusion on myocardial injury of patients with coronary artery abnormality after non-cardiac surgery.Methods Totally 90 patients with selective radical resections of gastric, intestinal and esophageal cancers were randomly divided into ozonated autohemotransfusion group (n=45) and control group (n=45). The ozonated autohemotransfusion group was treated with ozonated autohemotransfusion therapy at the time points of the day of operation and the first day and second days after operation, while the control group was only treated with autohemotransfusion. Venous blood was collected for detection of cardiac troponin I (cTnI) and cardiac troponin T (cTnT) in plasma at the time points of before anesthesia (T0) and 6, 12, 24 and 48 hours after surgery (T1, T2, T3, T4). Tricuspid annular plane systolic excursion (TAPSE) and left ventricular ejection fraction (LVEF) were measured by transthoracic ultrasound. Vasoactive inotrope score (VIS), C reactive protein (CRP), interleukin-6 (IL-6) and intraoperative time-weighted average mean arterial pressure (TWA-MAP) were recorded at 24 hours after operation.Results The levels of cTnI and cTnT in both groups raised in varying degrees after surgery, and the cTnI and cTnT levels at T2, T3 and T4 in the ozonated autohemotransfusion group were significantly lower than those in the control group (P < 0.05). Compared with the control group, the LVEF and TAPSE at T1, T2 and T3 increased significantly in the ozonated autohemotransfusion group, while the VIS decreased significantly at 24 hours after operation (P < 0.05). Compared with the control group, the CRP and IL-6 significantly decreased at 24 hours after operation in the ozonated autohemotransfusion group (P < 0.05).Conclusion Ozonated autohemotransfusion can improve the myocardial injury of patients with coronary artery abnormality after non-cardiac surgery.
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表 1 2组患者一般资料比较(x±s)
指标 三氧治疗组(n=45) 对照组(n=45) 性别 男 25(55.6) 24(53.3) 女 20(44.4) 21(46.7) 年龄/岁 66.1±5.1 66.6±4.5 体质量指数/(kg/m2) 23.8±2.2 24.1±2.6 手术类型 胃癌 18(40.0) 18(40.0) 肠癌 18(40.0) 17(37.8) 食管癌 9(20.0) 10(22.2) 合并高血压 30(66.7) 29(64.4) 合并糖尿病 24(53.3) 23(51.1) 合并高血脂 26(57.8) 25(55.6) 心功能分级 Ⅱ级 36(80.0) 37(82.2) Ⅲ级 9(20.0) 8(17.8) 冠状动脉病变情况 单支病变 20(44.4) 17(37.8) 双支病变 19(42.2) 22(48.9) 三支病变 6(13.4) 6(13.3) 冠状动脉支架植入 27(60.0) 25(55.6) 
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表 2 2组围术期cTnI及cTnT比较(x±s)
mg/mL 指标 时点 三氧治疗组(n=45) 对照组(n=45) cTnI T0 0.012±0.002 0.013±0.002 T1 0.053±0.011** 0.066±0.009** T2 0.066±0.012**## 0.161±0.023** T3 0.042±0.009**## 0.072±0.010** T4 0.019±0.004**## 0.053±0.007** cTnT T0 0.040±0.010 0.040±0.010 T1 0.070±0.010** 0.080±0.020** T2 0.110±0.020**## 0.150±0.020** T3 0.090±0.020**## 0.130±0.020** T4 0.050±0.010**## 0.100±0.140** cTnI: 心肌肌钙蛋白I; cTnT: 心肌肌钙蛋白T; T0: 麻醉前; T1: 术后6 h; T2: 术后12 h; T3: 术后24 h; T4: 术后48 h。与T0时比较, **P < 0.01; 与对照组比较, ##P < 0.01。
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表 3 2组LVEF和TAPSE比较(x±s)
指标 时点 三氧治疗组(n=45) 对照组(n=45) LVEF/% T0 51.2±2.3 50.8±2.6 T1 48.8±2.6**# 45.6±2.9** T2 47.3±2.6**# 44.7±2.2** T3 48.5±2.5**# 46.1±2.5** T4 50.8±2.1 49.6±2.2 TAPSE/mm T0 13.5±1.6 13.3±1.5 T1 12.6±1.2**## 10.8±1.3** T2 11.8±0.9**# 10.6±1.0** T3 13.5±2.1**# 11.9±2.2** T4 13.6±1.0 13.1±1.5 LVEF: 左室射血分数; TAPSE: 三尖瓣前叶瓣环的移位; T0: 麻醉前; T1: 术后6 h; T2: 术后12 h; T3: 术后24 h; T4: 术后48 h。与T0时比较, **P < 0.01; 与对照组比较, #P < 0.05, ##P < 0.01。
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表 4 2组患者TWA-MAP及VIS比较(x±s)
指标 三氧治疗组(n=45) 对照组(n=45) TWA-MAP/mmHg 83.4±6.8 82.8±5.9 VIS/分 2.1±1.2** 3.4±1.4 TWA-MAP: 时间加权平均动脉压; VIS: 血管活性药物分数。与对照组比较, **P < 0.01。
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表 5 2组患者围术期CRP及IL-6比较(x±s)
指标 时点 三氧治疗组(n=45) 对照组(n=45) CRP/(mg/L) 术前 12.1±7.6 12.4±8.5 术后24 h 34.5±20.8* 46.1±25.2 IL-6/(pg/mL) 术前 20.5±5.7 18.8±5.5 术后24 h 28.9±7.1* 34.6±10.4 CRP: C反应蛋白; IL-6: 白细胞介素-6。与对照组比较, *P < 0.05。
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