磷酸肌酸钠对肝下下腔静脉联合门静脉阻断术围术期心肌酶的影响

Effects of phosphocreatine sodium on serum myocardial enzymes in patients undergoing hepatectomy with portal vein occlusion combined with damping the inferior vena below the liver

目的探讨磷酸肌酸钠对围术期心肌酶的影响。方法选择择期采用肝下下腔静脉联合门静脉阻断行肝部分切除手术患者40例,随机均分为两组:Ⅰ组磷酸肌酸钠2.0g在术前30min开始输注,术后继续应用磷酸肌酸钠;Ⅱ组未用磷酸肌酸钠,给等剂量生理盐水。记录围术期HR、CVP以及MAP变化。于麻醉前、术后1、3、5d和7d抽血测定α-羟丁酸脱氢酶(α-HBD)、磷酸肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、乳酸脱氢酶(LDH)、谷丙转氨酶(ALT)和谷草转氨酶(AST)。结果与麻醉前比较,两组术后α-HBD浓度升高并持续到术后7d(P<0.05),术后1d和3dⅠ组增高的幅度比Ⅱ组小(P<0.05)。CK升高并持续到术后5d(P<0.05),Ⅰ组增高的幅度均比Ⅱ组小(P<0.05)。CK-MB和LDH分别于术后1d和3d升高(P<0.05),但术后1dⅠ组增高的幅度比Ⅱ组小(P<0.05)。ALT升高并持续到术后7d,Ⅰ组增高幅度均比Ⅱ组小(P<0.05)。AST升高并持续到术后7d(P<0.05),术后1d和3dⅠ组增高的幅度比Ⅱ组小(P<0.05)。结论围术期给予磷酸肌酸钠可以在一定程度上减轻肝下下腔静脉联合门静脉阻断所引起的心肌酶释放,对心肌损害有一定的保护作用。

Objective To investigate the effects of phosphocreatine sodium on serum myocardial enzyme level in patients with portal vein occlusion combined with damping the inferior vena below the liver. Methods Forty patients undergoing selective hepatectomy were randomly divided into two groups of I given phosphocreatine sodium 2.0 g at 30 min before operation and II given normal saline as the control. HR, CVP and MAP were recorded perioperatively and serum samples were collected for determination of α-HBD, CK, CK-MB, LDH, ALT and AST before anesthesia, on the 1^st , 3^rd , 5^th and 7^th postoperative day. Results Compared to that before anesthesia, serum α-HBD after operation increased for 7 days in two groups （P〈0.05）, which was less in group I than that in group II on the 1^st and 3^rd fiostoperative day （P〈0.05）. The increase of CK after operation lasted for 5 days in two groups （P〈0.05）, which was less in group I than that in group II （P〈0.05）. Compared to those before anesthesia, serum CK-MB and LDH after operation increased on the 1^st and 3^rd postoperative day respectively in two groups （P〈0.05）, which were less in group I than those in group II on the 1^st postoperative day （P〈0.05）. The increase of serum AST level after operation lasted for 7 days in two groups （P〈0.05）, which was less in group I than that in group II on the 1^st and 3^rd postoperative day （P〈0.05）. Conclusion The results suggest that phosphocreatine sodium could reduce myocardial enzyme release and have protective effect on myocardial injury induced by portal vein occlusion combined with damping the inferior vena below the liver.