腺苷在成人心脏外科手术中心肌保护作用的临床观察

The Clinical Study on the Myocardial Protective Effect of Adenosine in Adult Open Heart Surgery

目的观察腺苷在成人心脏外科手术中的心肌保护效果。方法45例成人心脏手术患者随机分为三组,每组15例,分别为对照组(Ⅰ组)、腺苷停搏液组(Ⅱ组)、腺苷停搏液+预处理组(Ⅲ组)。测定围术期血浆心肌肌钙蛋白I(cTnI)、肌酸激酶同工酶(CKMB)、乳酸脱氢酶(LDH)、白细胞介素-6(IL-6)、白细胞介素-8(IL-8)水平。术中取心肌组织观察心肌缺血前后超微结构改变。临床观察心脏停跳时间、自动复跳率、术后多巴胺用量、术后拔管时间、ICU滞留时间。结果Ⅰ组心脏停搏时间明显长于其他两组。主动脉开放后10 min,cTnI、IL-8Ⅰ组高于Ⅱ组与Ⅲ组(P<0.05),术后1dⅠ组IL-6高于Ⅱ组与Ⅲ组(P<0.05)。超微结构观察Ⅰ组心肌损伤程度较Ⅱ组、Ⅲ组重。结论腺苷可减轻心肌缺血再灌注损伤,具有较好的心肌保护作用。

OBJECTIVE To investigate the myocardial protective effect of adenosine in adult open heart surgery.METHODS Forty-five patients undergoing elective valve replacement operation were randomly divided to three groups： control group（groupⅠ,n=15）,adenosine cardioplegia group（groupⅡ,n=15）,adenosine cardioplegia and pretreatment group（group Ⅲ,n=15）.Plasma levels of cardiac troponin I（cTnI）,and creatine kinase MB（CKMB）,lactate dehydrogenase（LDH）,interleukin-6（IL-6） and interleukin-8（IL-8） were measured perioperatively.Biopsies of right atrium were taken to be analyzed under electron microscope.Arrest time,spontaneous resuscitation rate,the requirement for inotropics,intubation time and ICU stay time were also evaluated.RESULTS Group Ⅰ had higher cTnI and IL-8 values compared to group Ⅱ and group Ⅲ（P〈0.05） at 10 min after aotic declamping,and also had higher IL-6 compared to group Ⅱ and group Ⅲ（P〈0.05） at the point of 1 postoperative day.Ultrastructure changes were slighter in group Ⅱ and group Ⅲ than in group Ⅰ.Arrest time of group Ⅰ was longer than group Ⅱ and group Ⅲ（P〈0.05）.CONCLUSION Adenosine can decrease the ischemia-reperfusion injury,with better myocardial protective effect.