پایان نامه مقایسه تاثیر دو روش متفاوت حفاظت از میوکارد حین عمل جراحی پیوند عروق کرونر با ارزیابی تغییرات آنزیمی

فصل اول: مقدمه ......................................................................................................................................... 2

فصل دوم: مروری بر تحقیقات پیشین

1-2- آناتومی وفیزیولوژی قلب.............................................................................................................. 6

2-2- متابولیسم عضله قلبی.................................................................................................................. 7

2-2-1 - منابع انرژی در عضله قلبی........................................................................................... 7

2-2-2- گلیکولیز بی هوازی.......................................................................................................... 8

2-3- ایسکمی قلب ................................................................................................................................. 9

2-3-1- اختلالات میوکارد در ایسکمی.................................................................................... 10

2-3-2- ایسکمی و رادیکال های آزاد اکسیژن....................................................................... 11

2-3-3- آسیب ناشی از پرفیوژن مجدد.................................................................................... 12

2-3-4- ادم میوکارد....................................................................................................................... 12

2-4- آنزیمهای آنتی اکسیدان............................................................................................................ 13

2-4-1- عوامل اکسیدان................................................................................................................ 13

 2-4-2-  منابع اصلی ایجاد کننده رادیکالهای فعال اکسیژن

در بدن موجود زنده:......................................................................................................................... 14

2-5- استرس اکسیداتیو....................................................................................................................... 14

2-5-1- هیپوکسی و استرس اکسیداتیو.................................................................................. 17

عنوان                                                                                                                      صفحه

2-6- آنتی اکسیدانها ودفاع آنتی اکسیدانی.................................................................................... 18

2-6-1- سوپراکسید دیسموتاز SOD......................................................................................... 19

2-6-2- کاتالاز CAT...................................................................................................................... 20

2-6-3- گلوتاتیون پراکسیداز GPX........................................................................................... 21

2-6-4- مالون دی آلدهید MDA............................................................................................... 22

2-6-5- کراتین فسفوکیناز CPK............................................................................................... 24

2-6-5-1- آیزوآنزیمهای CPK............................................................................................ 25

2-6-6- تروپونین آی قلبی cTn I............................................................................................... 26

2-7- تاریخچه حفاظت از میوکارد...................................................................................................... 28

2-8- روش جراحی پیوند عروق کرونر............................................................................................. 31

2-9- اقدامات سودمند در حین پرفیوژن مجدد............................................................................. 33

2-10- عوامل مؤثر در حفاظت از میوکارد در زمان جراحی ...................................................... 34

2-10-1- بی حرکتی کامل قلب ............................................................................................... 34

2-10-2- کاهش درجه حرارت قلب.......................................................................................... 35

2-10-3- جلوگیری از پیدایش ادم............................................................................................ 35

2-10-4- سیستم بافری جهت خنثی کردن اسیدوز............................................................ 35

2-10-5- تنظیم کلسیم................................................................................................................ 36

2-10-6- جلوگیری از اثرات سوء رادیکال های اکسیژن...................................................... 36

2-10-7- آدنوزین........................................................................................................................... 37

2-10-8- نیتریک اکساید.............................................................................................................. 37

2-10-9- سیستم کمپلمان.......................................................................................................... 38

2-10-10- استفاده از عوامل هیپرپلاریزه................................................................................ 38

2-10-11- مهار تبدل کننده سدیم-هیدروژن....................................................................... 38

2-10-12- کاردیوپلژی   Cardioplegia................................................................................. 38

2-11- انواع کاردیوپلژی................................................................................................................. 39

فصل سوم: مواد و روش کار

3-1- مواد و وسایل مورد نیاز............................................................................................................... 41

3-2- انتخاب بیماران مورد مطالعه..................................................................................................... 41

3-3- زمان نمونه گیری......................................................................................................................... 43

3-4- حجم نمونه گیری........................................................................................................................ 43

3-5- اندازه گیری فعالیت آنزیم سوپر اکسید دیسموتاز SOD................................................. 44

3-6- اندازه­گیری فعالیت آنزیم گلوتاتیون پراکسیداز GPX....................................................... 44

3-7- اندازه‌گیری فعالیت آنزیم کاتالاز CAT درگلبول‌های قرمز خون.................................... 45

3-8- اندازه گیری مالون دی آلدهید MDA در گلبول های قرمز خون................................... 46

3-9- روشهای اندازه گیری آنزیم کراتین فسفو کیناز CPK...................................................... 46

3-9-1- اصول روش کالریمتری.................................................................................................. 46

3-9-2- اندازه گیری CPK به روش فلوئورومتری................................................................. 47

3-9-3- روش جدید کالریمتری برای اندازه گیری CPK................................................... 47

3-9-4- اندازه گیری CPK با روش اسپکتروفتومتری.......................................................... 48

3-10- روش اندازه گیری CPK و تروپونین   cTn Iدر این مطالعه......................................... 48

فصل چهارم: نتایج

4-1- بررسی تغییرات میزان آنزیم SOD در طول مطالعه......................................................... 50

4-2-  بررسی تغییرات میزان آنزیم GPX...................................................................................... 51

4-3-  بررسی تغییرات میزان آنزیم کاتالاز...................................................................................... 52

عنوان                                                                                                                      صفحه

4-4-  بررسی تغییرات MDA............................................................................................................. 52

4-5-  بررسی تغییرات آنزیم CPK-MB......................................................................................... 54

4-6- بررسی تغییرات cTnI................................................................................................................. 54

فصل پنجم: بحث

5-1- آنزیمهای آنتی اکسیدانی (SOD, GPX, CAT)................................................................. 57

5-2- فاکتور MDA................................................................................................................................. 60

5-3- تروپونین قلبی و CPK-MB...................................................................................................... 61

نتیجه گیری...................................................................................................................................................... 64

پیشنهادات........................................................................................................................................................ 65

فهرست منابع و مآخذ

منابع فارسی ............................................................................................................................................ 66

منابع انگلیسی

منبع:

منابع فارسی

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