磷酸肌酸钠用于心脏瓣膜置换患者的临床观察

Clinical observation of Creatine Phosphate Sodium in Patients Undergoing Cardiac Valve Replacement

目的观察磷酸肌酸钠对心脏瓣膜置换患者血流动力学、心肌肌钙蛋白I(CTnI)、心脏复跳方式和血管活性药使用情况的影响。方法择期体外循环(cardiopulmonary bypass,CPB)下行心脏瓣膜置换患者40例,年龄32～60岁,美国麻醉医师协会(American Society of Anesthesiologists,ASA)分级Ⅱ～Ⅲ级,随机分为两组(n=20):对照组(A组)和磷酸肌酸钠组(B组),B组在入室后和心脏停搏液中给予磷酸肌酸钠,A组给予等量生理盐水。分别于麻醉前即刻(T1)、转机前即刻(T2)、停机后即刻(T3)、手术结束(T4)各时点记录平均动脉压(MAP)和心率(HR)。于给予磷酸肌酸钠前即刻(T0),T3、T4和术后24h(T5)抽静脉血测CTnI含量。同时记录心脏复跳方式及血管活性药使用情况。结果两组间MAP和HR在T1～T4各时点无明显差别,组内CTnI在T3～5各时点较T0明显升高(P<0.01)。与A组相比,B组CTnI在T3～T5各时点明显降低(P<0.01),心脏自动复跳率明显升高(P<0.05),术毕多巴胺用量大于6μg/(kg.min)者明显减少(P<0.05)。结论磷酸肌酸钠对心脏瓣膜置换患者有良好的心肌保护作用。

Objective To investigate the influence of creatine phosphate sodium on hemodynamics,cardiac troponin I（CTnI）,cardiac recovery and use of vasoactive drugs in patients undergoing cardiac valve replacement under cardiopulmonary bypass（CPB）.Methods 40 ASA Ⅱ or Ⅲ patients aged 32-60 years undergoing cardiac valve replacement under CPB were randomly divided into 2 groups（n=20 each）：group B received creatine phosphate sodium 1.0 g/h before CPB and cardioplegic solution with 10 mmol/L creatine phosphate sodium;group A received normal saline（NS）.Blood samples were taken immediately before giving creatine phosphate sodium（T0）,immediately after discontinuation of CPB（T3）,immediately after the operation（T4） and 24 hours after the operation（T5） to measure the serum levels of CTnI.Mean arterial pressure（MAP） and heart rate（HR） were recorded before anesthesia（T1）,immediately before CPB（T2） and T3-T4.The use of vasoactive drugs and the rate of recovery of spontaneous heart beat in both groups were also recorded.Results There was no significant difference in MAP and HR at T1-T4 between 2 groups.CTnI was significantly increased at T3-T5 than that of T0 in two groups（P0.01）.Compare with group A,CTnI was significantly lower at T3-T5（P0.01） and the rate of recovery of spontaneous heart beat was significantly higher（P0.05）and the number of patient given dopamine with dosage higher than 6 μg/kg·min was significantly lower at the end of the operation（P0.05） in group B.Conclusion Creatine phosphate sodium can enhance myocardial protection in patients undergoing cardiac valve replacement.