预防性服用尼卡地平防治低温体外循环心肌损伤

PRETREATMENT WITH NICARDIPINE AGAINST MYOCARDIAL DAMAGE IN HYPOTHERMIC EXTRACOPOREAL CIRCULATION

采用预防性服用尼卡地平的方法，在２１例经低温体外循环手术的病例中进行临床对照试验。结果：服药组心肌电镜下超微结构较对照组得到了较好的保护，心电图心肌缺血损伤表现和心肌内肌酸磷酸激酶及其同工酶和谷草转氨酶的释放以及丙二醛的产生均少于对照组，与此相应服药组术后早期临床恢复也明显优于对照组。结果提示预防性服用尼卡地平有对抗心肌缺血－再灌注损伤的作用，其机制可能与保存能量贮备和对抗氧自由基损伤有关，因此使之得以在心肌温度低于２３．５℃的低温体外循环中发挥进一步的心肌保护作用，具有一定的临床应用价值。

Acontrolled clinical trial was carried out in 21 patients undergoing hypothermic cardiopulmonary bypass surgery with nicardipine given preoperatively In the treated group.The results showed that electromicroscopic structures were better preserved in the treated group, whereas in the control group,there were more eases of postoperative ischemic changes on ECG as well as higher serum CPK,CMB,GOT an d MDA levels.Corresponding:ly,early postoperative recovery were also much better in the treated group than in the control group.Thus, Nicardipine pretreatment was found to be protective against myocardial ischemia-reperfusion injury with its effects related to an energy-saving and anti-free radical mechanism.We conclude that nicadipine,when used prophylactically,could still demonstrate its effect against myocardial damage in hypothermic extracorporeal circulation with myocardial temperature less than 23.5℃,and this method was of certain therapeutic value.