外源磷酸肌酸对法洛四联症的心肌保护作用

Immature Myocardial Protective Function of Creatine Phosphate

目的:探讨外源磷酸肌酸(CP)对先天性心脏病法洛四联症(TOF)矫治术的心肌保护作用。方法:将20例择期行TOF矫治术患儿,随机分为CP组和对照组,CP组在ST.Thomas’停搏液中加入磷酸肌酸钠(每1 L中加入2.5 g磷酸肌酸钠)。观察两组心肌电生理指标,正性肌力药用量,分别于体外循环转流前、开放循环后30 min、术后6,12,24 h采取桡动脉血检测肌酸激酶同工酶(CK-MB)、心肌肌钙蛋白I(cTnI)。取右心耳组织观察心肌超微结构。结果:两组主动脉阻断时间无明显差异。术后6 h,CP组cTnI为(0.69±0.20)μg/L,CK-MB为(17.19±11.48)U/L,分别低于对照组(0.86±0.97)μg/L和(49.32±17.56)U/L(P<0.01)。CP组心肌超微结构保存较好,损伤较对照组小。结论:CP作为有效的停搏液成分,对婴幼儿未成熟心肌产生明显保护作用。

Objective： To investigate the myocardial protective effects of creatine phosphate in infants undergoing open heart surgery with Tetralogy of Fallot （TOF）. Methods： Twenty infant patients with TOF underwent operations with cardiopulmonary bypass. They were randomly divided into ereatine phosphate and control group. Cardiac electro-physiologic data and inotropie medicine dosage were recorded. Myoeardium enzymes and cardiac troponin I （eTnI） were measured in each group before the eardiopulmonary bypass, at 30 rain after the aorta off-clamping, and at 6, 12 and 24 h after operation respectively. The changes of myocardial uhrastrueture were studied. Results： There were no significant differences between the two groups in the time of the aorta clamping. At 6 h after operation, the eTnI and CK-MB in the CP group were significantly lower than that in the control group respectively, （0. 69±0.20） μg/L vs （0. 86± 0. 97）μg/L, and （17.19±11.48） U/L vs （49.32±7.56） U/L, respectively, and both P〈0.01. The inotropie medicine dosage in the ereatine phosphate group was much lower than that in the control group. The myocardial uhrastrueture in ereatine phosphate group was less damaged than that in the con- trol group. Conclusion： Creatine phosphate can enhance immature myocardial protection of crystal eardioplegia solutions.