米力农对心肺转流心瓣膜置换术患者心肌缺血-再灌注损伤的影响

Effects of milrinone on serum cardiac troponin I and creatine kinase-MB in patients undergoing cardiac valve replacement

目的 比较心肺转流 (CPB)下心瓣膜置换术使用米力农和硝酸甘油时患者血浆中心肌肌钙蛋白I(cTnI)及肌酸激酶同功酶MB(CK MB)水平的变化 ,了解其对心肌缺血 再灌注损伤的影响。方法 择期心内直视手术心瓣膜置换患者 2 4例 ,分为米力农组 (M组 )和硝酸甘油组 (N组 ) ,每组 12例。分别于全麻诱导前 (T0 )、主动脉开放后 10min(T1)和术毕 (T2 )抽取患者中心静脉血 ,测定cTnI和CK MB血浆水平。结果 M组cTnI在T1和T2 均较N组低 (P <0 0 5 )。两组CK MB组间比较M组略低于N组 (P >0 .0 5 )。M组和N组内cTnI、CK MB在T1和T2 所测定值均高于T0(P <0 0 5 ) ,且T2 高于T1(P <0 0 5 )。两组cTnI、CK MB随时间推移呈明显上升趋势。结论 CPB下行心瓣膜置换术时使用米力农比使用硝酸甘油更有可能改善心肌的缺血

Objective To compare the effects of milrinone and nitroglycerin on cardiac troponin (cTnI) and creatine kinase-MB (CK-MB) responses in patients undergoing cardiac valve replacement under cardiopulmonary bypass (CPB).Methods This double-blinded randomized clinical study enrolled 24 adult patients with compromised cardiac function scheduled for elective valve replacement surgery. Patients were divided into milrinone group (M) and nitroglycerin group (N). Serum levels of cTnI and CK-MB were measured just prior to induction of anesthesia(T 0), at 10 min after aortic declamping (T 1) and completion of surgery (T 2). The concentrations of cTnI or CK-MB were analyzed by immunoassay.Results Compared with group N, a significant decrease of cTnI in group M was noted at T 1 and T 2(P<0.05). Compared with T 0, both cTnI and CK-MB were all higher at T 1 and T 2(P<0.05). Compared with the value of T 1, both cTnI and CK-MB increased significantly at T 2 in both groups (P<0.05). Conclusion Continuous infusion of milrinone may result in a less incidence of myocardial ischemia and myocardial cell damage than that of nitroglycerin in patients undergoing cardiac valve replacement under CPB.