川芎嗪预处理对体外循环后心肌损伤的保护作用

Protective effect of tetramethylpyrazine pre-conditioning on the myocardial injury after cardiopu-lmonary bypass

目的探讨川芎嗪预处理在体外循环(CPB)心脏手术中的心肌保护作用及机制。方法28例非发绀型先天性心脏病患者,随机分为对照组和川芎嗪预处理组,每组14例。川芎嗪预处理组患者麻醉诱导后经颈内静脉滴入川芎嗪3mg/kg,30min滴完,转流后追加1mg/kg于氧合器中,对照组于上述时间给予等量生理盐水。两组分别于转流前、主动脉开放后30min和术后24h测定外周血天冬酸氨基转移酶(AST)、乳酸脱氢酶(LDH)、肌酸磷酸激酶(CK)和肌酸磷酸激酶同工酶(CK-MB)的变化。同时,分别于转流前和主动脉开放后30min取右心耳心肌组织,观察心肌超微结构变化。结果两组主动脉阻断时间比较差异无统计学意义。CPB期间两组患者心肌损伤指标AST、LDH、CK、CK-MB明显升高(P<0.05),川芎嗪组心肌酶含量明显低于对照组(P<0.05)。川芎嗪组心肌超微结构受损较对照组为轻。川芎嗪组CPB后线粒体计分明显低于对照组(P<0.05)。结论川芎嗪预处理使患者心肌超微结构损害减轻,心肌线粒体结构和功能的完整性得到保护,心肌酶漏出减少,故川芎嗪预处理在CPB手术中有较好的心肌保护作用和应用前景。

Objective To investigate the myocardioprotective effects of tetramethylpyrazine （TMP）pre - conditioning on the patients with open heart surgery. Methods 28 non - cyanotic patients of congenital heart disease were randomly divided into the control group （ n = 14） and the TMP group （ n = 14）. 3 mg/kg TMP was given to the TMP treatment group by intravenous drop infusion after anesthesia induction and finished within 30 minutes, then 1 mg/kg was added to oxygenator during CPB. Peripheral levels of AST, LDH, CK, CK - MB were measured before the CPB and 30 minutes after aorta declamping and 24 hours after cardiosurgery as the markers of heart damage. The myocardial uhrastructure was also observed before the CPB and 30 minutes after aorta declamping. Results The levels of AST, LDH, CK, CK - MB in the TMP group were lower than those in the control group（ P 〈0.05 ）. The scores of myocardial mitochondria in the TMP group were lower than those in the control group after CPB （ P 〈 0.05 ）. The damage of myocardial ultrastructure was lighter in the TMP group, compared with control group after CPB. Conclusion TMP pre - conditioning can protect myocardial mitochondria from ischemia reperfusion injury, and attenuate CPB -induced myocardial ischemia reperfusion injury by a selfprotective mechanism.