磷酸肌酸钠对腹腔镜前列腺癌根治术患者心肌损伤的影响

Effect of phosphocreatine on myocardial injury induced by carbon dioxide preumoperitoneum in patients undergoing laparoscopic radical prostatectomy

目的探讨磷酸肌酸钠预给药对CO2气腹致腹腔镜前列腺癌根治术患者心肌损伤的影响。方法选择2009年1月至2010年12月我院择期腹腔镜前列腺癌根治术患者40例,年龄60～80岁,美国麻醉师协会(ASA)Ⅱ～Ⅲ级。随机分为2组:磷酸肌酸钠预给药组(P组)、对照组(C组),每组20例。麻醉前开放静脉通路,P组在麻醉诱导前以磷酸肌酸钠2g加生理盐水稀释至20ml静脉微量泵注,60min内泵完。C组以等量生理盐水代替。分别于麻醉诱导前、术毕、术后8h采集静脉血样,测定心肌酶谱即血清肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、AST和乳酸脱氢酶(LDH)的活性。结果 (1)麻醉诱导前两组的心肌酶谱无统计学差异(P>0.05);(2)术毕时:C组CK、CK-MB和AST水平比P组显著升高(P<0.05);术后8h时:C组CK、CK-MB、AST和LDH水平均比P组显著升高(P<0.05)。结论磷酸肌酸钠对腹腔镜前列腺癌根治术致心肌损伤具有保护作用。

Objective To evaluate the effect of phosphocreatine pretreatment on myocardial injury induced by carbon dioxide preumoperitoneum in patients undergoing laparoscopic radical prostatectomy.Methods Forty ASA Ⅱor Ⅲ patients with prostatic cancer aged 60 80,weighing 45 60 kg were randomly divided into two groups(20 casesin each group):phosphocreatine group(group P)and control group(group C).Intravenous drip of phosphocreatine was given(2 g,diluted with normal saline to 20 ml,in 1 hour)after anaesthesia induction in group P,and group C received normal saline instead.Blood samples were drawn from central vein at preoperative stage,end of operation,8 hours after operation.Then the myocardial zymogram(CK,CK-MB,AST,LDH)was determined.The cardiac complications were observed after operation.Results(1)There was no difference between the two groups before anesthesia induction.(2)The values of myocardial zymogram(CK,CK-MB,AST,LDH)in group C were higher than those of group P at 8 hours after operation(P<0.05).Conclusions Phosphocreatine can protect myocardium in patients undergoing laparoscopic radical prostatectomy.