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目的探讨心肌缺血预适应 (IP)对围术期血浆血管内皮生长因子 (VEGF)水平的影响及其临床意义。方法 2 0例择期心脏手术患者随机均分为两组 ,对照组常规建立体外循环 (CPB) ,阻断升主动脉后经主动脉根部顺灌 4℃StThomas′停搏液 ;IP组实施 3分钟缺血 ,5分钟再灌注后余同对照组。于不同时点取桡动脉血 2ml,采用酶联免疫吸附 (ELISA)法测定VEGF浓度。结果对照组在主动脉阻断 30分钟时VEGF浓度开始上升 ,术后 6小时达到高峰 (P <0 0 1) ,2 4小时仍明显高于正常 (P<0 0 1) ;IP组在IP结束时VEGF水平迅速升高 (P <0 0 1) ,主动脉阻断 30分钟时达高峰 (P <0 0 1) ,主动脉开放 30分钟时开始下降 ,术后 2 4小时已基本降至正常。结论IP可诱导VEGF生成增加 ,这可能也是IP的心肌保护机制之一。
Objective To investigate the effect of myocardial ischemic preconditioning (IP) on the level of plasma vascular endothelial growth factor (VEGF) in perioperative period and its clinical significance. Methods Twenty patients undergoing elective cardiac surgery were randomly divided into two groups. The control group was given cardiopulmonary bypass (CPB) routinely. The ascending aorta was occluded and the aortic root was infused with StThomas’ cardioplegia at 4 ℃. The IP group was administered for 3 minutes Ischemia, more than 5 minutes after reperfusion with the control group. Radial artery blood was taken at different time points and the concentration of VEGF was measured by enzyme-linked immunosorbent assay (ELISA). Results In the control group, VEGF concentration began to rise 30 minutes after the aorta occlusion, peaked at 6 hours after operation (P <0.01), and remained significantly higher at 24 hours (P <0.01) At the end of the experiment, the level of VEGF increased rapidly (P <0.01), the aorta peaked at 30 minutes (P <0.01), the aorta began to decline 30 minutes after opening, and the level of VEGF decreased after 24 hours normal. Conclusions IP can induce the increase of VEGF production, which may be one of the mechanisms of IP myocardial protection.