心肌停跳液中加入吗啡对体外循环心脏手术心肌的保护作用

Protective effect of morphine added in the cardioplegic solution on the myocardium

目的研究心肌停跳液中加入吗啡对心肺转流(CPB)心脏手术中心肌的保护作用。方法40例行瓣膜置换术的患者随机均分成两组:吗啡组(M组),心肌停跳液中加吗啡2μmol/L;对照组(C组),停跳液中未加吗啡作为对照。比较两组心肌细胞凋亡率、心肌细胞超微结构变化、术后低心排和严重心律失常发生率、拔除气管导管时间、ICU停留时间、平均住院天数,测定主动脉开放后2、12、24h磷酸肌酸激酶同工酶(CK-MB)、心肌肌钙蛋白(cTnI)水平。结果两组术后心肌细胞凋亡率均较术前显著增加(P<0.01),但M组较C组明显减少(P<0.05);M组术后心肌细胞核膜、线粒体肿胀较C组轻,嵴较清晰。M组在主动脉开放后2、24h的血cTnI的水平较C组明显降低(P<0.05)。结论心肌停跳液中加入一定剂量的吗啡对CPB后心肌有保护作用。

Objective To investigate the effects of morphine added into the cardioplegic solution on the myocardium during cardiopulmonary bypass （CPB）. Methods Forty patients undergoing heart valves replacement were randomly assigned to group M（morphine 2 μmol/L in the cardioplegic solution） and group C （no morphine in the cardioplegic solution）. The myocardial apoptosis were assessed by terminal deoxynudeotide transferase-mediated deoxyuridine triphosphate nickend lebelling （TUNEL）. The morphological changes of apoptosis were observed by electroscope. The post operation incidence of severe ventricular arrhythmia and low cardiac output, duration of ventilation and ICU and hospital stay, were recorded. The blood samples were taken for detecting creatine kinase-MB（CK-MB） and cardiac troponin I（cTnI） as well at 2, 12,and 24hours after aortic declamping. Results The level of apoptosis after CPB was elevated in both groups compared with those before CPB,which was more in group C than that in group M （P〈0.05）. The morphological changes in group M was less than that in group C. The levels of cTnI at 2 and 24 hours after aortic declamping in group M were lower than those in group C （P〈0.05）. Conclusion A certain dose of morphine added into cardioplegic solution has protective effect on the myocardium during CPB.