环磷酸腺苷葡胺对冠心病患者行非心脏手术心肌保护作用的临床研究

Myocardial Protection of Megluming Cyclic Adenylate during Non-cardiac Surgery in Patients with Coronary Artery Disease

目的观察环磷酸腺苷葡胺对冠心病患者行非心脏手术心肌的保护作用。方法选择90例行上腹部手术的冠心病病人,随即分为A、B、C三组,A组:麻醉诱导前20 min M-cAMP2 mg/kg静滴;B组:麻醉诱导前10 min M-cAMP静注20 mg,随后2 mg/kg加入100 ml生理盐水中持续缓慢静滴至术毕;C组:麻醉诱导前10 min静注等量的生理盐液,然后100 ml生理盐液持续静滴。观察麻醉诱导前、术后8 h、术后24 h血浆CK-MB、IL-6、TNF-α、SOD、MAD的变化。结果A、B、C三组与T1相比CK-MB、TNF-α、IL-6、MDA血浆浓度均有显著增高(P<0.05),血浆SOD浓度显著降低,A、B组与C组相比变化幅度具有显著统计学差异(P<0.05)。结论M-cAMP在冠心病患者行非心脏手术时对心肌有保护作用。

Objective To investigate the myocardial protection of megluming cyclic adenylate （M-cAMP） during non - cardiac surgery in the patients with coronary artery disease. Methods Ninty patients scheduled for elective abdominal operations were randomly allocated into Group A, B and C. In Group A （ n = 30 ） , 2 mg/kg of M-cAMP was infused 20 minutes earlier before induction of anesthesia. In Group B （ n = 30） , 20 mg of M-cAMP was infused 10 minutes earlier before induction of anesthesia, and 2mg/kg of M-cAMP was continuously infused during operation. In Group C （ n = 30） , 100 ml of isotonic saline solution was continuously infused during operation. Arterial blood samples were collected immediately before induction of anesthesia, and 8 and 24 hours after operation. Some parameters, such as creatine kinase （CK） -MB, tumor necrosis factor （TNF） -α, interleukin （IL） -6, superoxide dismutase （SOD） and malondialdehyde （MDA）, were measured. Results The levels of CK-MB, TNF-α, IL-6 and MDA increased in all the three groups, and the activity of SOD decreased in all the three groups （ P 〈 0.05 ） , but there was significant difference in fluctuation between Group A or B and Group C （P 〈 0.05）. Conclusion M-cAMP can protect cardiac muscle during non-cardiac Surgery in the patients with coronary artery disease.