磷酸肌酸含血灌注液对心脏瓣膜置换术心肌的保护作用

Myocardial protective effect of antegrade intermittent blood cardioplegia with exogenous creatine phosphate in patients undergoing valve replacement

目的观察含血圣.托马斯2(STH2)液加入外源性磷酸肌酸对二尖瓣或主动脉瓣瓣膜置换术患者的心肌保护作用。方法30例同期行二尖瓣或主动脉瓣瓣膜置换术患者随机分为两组,磷酸肌酸治疗组灌注液中加入外源性磷酸肌酸,对照组用等量含血STH2液,分别经主动脉根部或切开主动脉冠状动脉窦灌注,观察心脏复跳、术后机械通气及监护室停留时间,两组分别于麻醉诱导前、后,主动脉阻断开放后61、6 h,采集患者中心静脉血,测血细胞比容(HCT)、肌酸激酶同工酶(CK-MB)、心肌钙蛋白I(cTnI)。结果磷酸肌酶治疗组心脏自动复跳率较对照组高,术后多巴胺用量较对照组少,两组术后CK-MB、cTnI较术前高,实验组较对照组高。结论外源性磷酸肌酸加入心灌注液中能显著提高心肌保护作用。

Objective To study the myocardial protective effect of exogenous creatine phosphate adding STH2 cardioplegia in patients undergoing mitral or aortic valve replacement （MVR or AVR）. Methods We observed the clinical effectiveness and measured the level of CK-MB and cTnI in 15 patients undergoing MVR or AVR with antegrade intermittent STH2 blood cardioplegia with exog enous creatine phosphate（study group）, and in another 15 patients without exogenous creatine phos phate（control group）. Blood samples were taken for determination of serum concentrations of HCT, CK-MB and cTnI before and after anaesthesia, at 6 h and 16 h after aortic declamping. Results There was no significant difference in the levels of CK-MB and cTnI before and after anaesthesia between two groups. But the levels of CK-MB and cTnI at 6 h and 16 h after aortic declamping were significantly lower in study group than those in control group. Conclusion Antegrade intermittent blood cardio plegia with exogenous creatine phosphate shows an effective myocardial protection in patients undergoing MVR or AVR.