葛根素停搏液在心内直视手术中心肌保护作用的临床研究

Protective Effect of Puerarine Cardioplegia in Open Heart Operation

目的:在动物实验基础上,结合临床实际情况,评估含葛根素停搏液对心肌的保护效果。方法:20例成年择期瓣膜替换患者,随机分成单纯停搏液的对照组,停搏液含葛根素的葛根素组各10例。阻断升主动脉前、开放后5分及15分从冠状静脉窦及动脉各抽取5ml血,测定血气、乳酸含量、丙二醛(MDA)含量;阻断升主动脉前、开放后2、4、24、48小时从颈内静脉抽取2 ml血,测定肌酸激酶(CK)及肌酸激酶同工酶(CK-MB)含量;阻断升主动脉前、开放后10分从左心房取心肌标本进行电镜观察。结果:体外循环后两组的血流动力学指标变化未见明显差异。葛根素组血清乳酸生成量(开放5分时)、MDA含量(开放15分时)、CK及CK-MB漏出量均少于对照组(P<0.05);开放升主动脉后10分,对照组心肌超微结构有明显缺血、缺氧性改变,而葛根素组变化不大(P<0.05)。结论:含葛根素的冷晶体停搏液在心肌乳酸、酶的释放以及超微结构等方面的心肌保护效果,明显优于单纯晶体停搏液。

Objective:The aim was to investigate the myocardial protection effects of crystalloid cardioplegic solu tion containing puerarine. Methods: Twenty adult patients with cardiac valve replacement were randomly divided into two groups. In the control group (n=10), hearts were perfused with crystalloid cardioplegic solution and in the treated group (n=10),hearts were perfused with crystalloid eardioplegic solution containing puerarine (2mg/kg). Arterial and coronary venous sinus blood samples were collected simultaneously for the measurement of oxygen,lactate, MDA,CK and CK-MB levels. Biopsy samples of the left atrium for electron microscopy were obtained before cross-clamping and 10 minutes after aorta opening. Resuks: ①The hemodynamic changes after CPB showed no difference between the two groups; ②5 minutes after aorta opening,lactate levels was lower in the treated group vs. the control group (p<0.05); ③15 minutes after aorta opening,MDA contents were lower in the treated group vs. the control group(p<0.05); ④The postoperative CK and CK-MB levels were lower in the treated group vs. the control group(p<0.05); ⑤The changes of myocardial ultrastructure before cross-clamp were similar between the two groups,but 10 minutes after aorta opening,the changes were more severe in the control than in the treated group. Conclusion: Crystalloid cardioplegic solution containing puerarine may ameliorate myocardial metabolism,by decreasing blood lactate and MDA contents,reducing postoperative CK and CK-MB release and protecting myocardial ultrastrueture following ischemia and repefusion.