磷酸肌酸温血心停搏液终末灌注对心肌保护作用的临床研究

Myocardial protection of cardioplegic solution with exogenous creatine phosphate in valve replacement

目的研究外源性磷酸肌酸（CP）对风湿性心脏病心瓣膜替换术患者在体外循环期间心肌再灌注损伤的保护作用。方法将46例风湿性心脏病体外循环心瓣膜替换术患者随机分为治疗组和对照组各23例。治疗组在开放主动脉前30min，在圣·托马斯（STH2）液中加入外源性磷酸肌酸终末温血半钾灌注，对照组应用常规圣·托马斯液。分别测定所有患者术前、主动脉开放2h、6h、24h、48h各时点中心静脉血中的红细胞压积（HCT）、乳酸脱氢酶（LDH）、磷酸肌酸激酶（CK）、磷酸肌酸激酶同工酶（CK-MB）及心脏肌钙蛋白T（cTnT）。记录术毕心脏自动复跳率和术后多巴胺用量。结果治疗组术后多巴胺用量明显少于对照组（P〈0．01）；术后6h、24h、48h的LDH、CK、CK-MB及cTnT水平均明显低于对照组（P〈0．01）；治疗组患者术毕心脏自动复跳率明显高于对照组。结论磷酸肌酸加入心停搏液中能显著提高心肌保护作用。

Objective To observe the myocardial protection of cardioplegic solution with creafine phosphate （CP） in valve replacement. Methods Fourty-six patients undergoing heart surgery were randomly divided into two groups： group A （study group） received eardioplegic solution with CP, and group B （control group） accepted No2 Thomas＇cardioplegic solution. Blood samples were taken to determine the serum concentrations of LDH.CK.CK-MB and cTnT after anaesthesia, then at 2h.6h.24h and 48h after aortic open-clamp. Results The rate of spontaneous beating in study group is higher than in control one; the dosage of dopamine hydrochlofidein the first 24 hours post operation in study group is lower than in control one; the levels of LDH.CK.CK-MB and cTnT at 6 h and 16h after aortic open-clamp were significantly lower in the study group than in the control one. Conclusion Antegrade intermittent blood cardioplegia with exogenous creatine phosphate shows effective myocardial protection in vavle replacement.