The impact of noninvasive limb ischemic preconditioning combined with postconditioning on ischemia/reperfusion injury

Abstract

Objective To explore the protective effect of noninvasive limb ischemic postconditioning ( NILIPC ) and preconditioning ( MLIPostC ) on ischemia/reperfusion injury during open heart surgery. Methods Sixty patients with rheumatic heart disease scheduled for heart mechanical valve replacement were randomly assigned to study group A , B, or C, or control group (15 patients for each group ). NILIPC or NILIPostC was performed 10 minutes before aorta clamping or off-clamping. Group A received NILIPC and group B received NILIPostC on the right thigh; group C received NILIPC on the right and NILIPostC on the left. The control group received routine treatment. Serum levels of creatine kinase-MB ( CK-MB ) and cardiac troponin-1 (cTnI) were measured preoperatively, at the moment of aorta clamping and off-clamping, and at 3h, 12h, 24h, and 72h after off-clamping. Results Levels of CK-MB and cTnI increased gradually after aorta off-clamping, peaked at 12h, then gradually decreased in all the patients. The control group had a largest increase, while group C had a smallest elevation and declined to the baseline at 72h. At 3h, 12h, 24h, and 72h after aorta off-clamping, levels of CK-MB and cTnI were higher in the control group than in group C ( P< 0.05, P< 0.01 ), but the mean levels of CK-MB and cTnI were lower, as compared with those in groups A and B. Conclusions Combination with NILIPC and NILIPostC may synergically protect myocardium from ischemia/reperfusion injury during open heart surgery. Key words: Limb ischemic preconditioning; Limb ischemic postconditioning; Noninvasive; Ischemia /reperfusion injury; Myocardial protection