磷酸肌酸含血心停搏液对联合瓣膜置换术心肌保护作用研究

The study of effect of antegrade intermittent blood cardioplegia with exogenous creatine phosphate on myocardium in mitrol and aortie valve replacemant

目的观察含血圣.托马斯(STH2)液加入外源性磷酸肌酸(CP)后对重症瓣膜病患者联合瓣膜置换术心肌保护作用。方法40例同期行二尖瓣、主动脉瓣置换术患者随机分为两组,CP治疗组在含血STH2心灌注液中加入CP,对照组用等量含血STH2液,分别切开主动脉根部经冠状动脉窦直接灌注,观察心脏复搏情况、术后机械通气及监护室停留情况。两组分别于麻醉诱导前、诱导后、主动脉阻断开放后6h、16h,采集患者中心静脉血,测血细胞比积(HCT)、磷酸肌酸激酶同工酶(CK-MB)、心肌钙蛋白I(cTn-I)。结果CP治疗组心脏自动复搏率较对照组高,术后多巴胺用量较对照组少,两组术后CK-MB、cTn-I较术前高,CP治疗组较对照组高。结论CP加入心停搏液中能显著提高心肌保护作用。

Objective To observe the clinical effectiveness of exogenous creatine phosphate adding STH2 cardioplegia in mitral and aortic valve replacement [MVR and AVR）. Methods We observed the clinical effectiveness and measured the release of CK-MB and cTn-I in 20 patients who underwent MVR and AV＇R with ante_grade intermittent blood cardioplegia with exogenous creatine phosphate （study group）, in. comparison with 20 patients who underwent MVR and AV＇R with antegrade intermittent blood cardioplegia without exogenous creatine phosphate （ control group. ）. Blood samples were taken to determine the serum concentrations of CK-MB and cTn-I before and after anaesthesia, then at 6h and 16h after aortic open-clamp. Results The rate of spontaneous beating in study group is higher than in control one; the dosage of dopamine hydrochloride in the first 24 hours post-operation in study group is lower than in control one;the levels of CKMB and cTn-I at 6h and 16h after aortic open-clamp were significantly lower in the study group than in the control one. Conclusion Antegrade intermittent blood cardioplegia with exogenous creatine phosphate shows effective myocardial protection in MVR and AVR.