左-卡尼汀在心内直视手术中对心肌的保护作用

The myocardial protective effects of L-carnitine under open cardiac operation

目的:探讨心内直视手术中外源性左-卡尼汀(L-CN)对心肌的保护作用。方法:选取心内直视手术的患者32例,随机分为实验组和对照组。实验组术中于冷晶体心脏停搏液中按10g/L加入L-CN,行冠状动脉顺行灌注;对照组仅使用冷晶体停搏液灌注。两组均于术前、主动脉阻断开放后2、24、72h各时点采取静脉血,测心肌酶(CK、CK-MB),肌钙蛋白I(cTnI)和肌钙蛋白T(cTnT)水平。结果:两组患者CK、CK-MB,cTnT、cTnI水平在术前比较,差异无统计学意义(P>0.05),于主动脉开放后均有明显的升高。实验组CK、CK-MB升高程度较对照组低(P<0.05)。实验组cTnT、cTnI升高程度在2、24及72h较对照组低(P<0.05),2h尤其明显(P<0.01)。结论:在心内直视手术中,左-卡尼汀加入心脏停搏液后可明显改善心脏能量供应,有效减少心肌细胞损伤,对心肌起到明显保护作用。

Objective：To investigate the myocardial protective effects of L-carnitine in patients with heart disease undergoing open cardiacoperation under cardio-pulmonary bypass（CPB）.Methods：Thirty-two patients undergoing open cardiac- operation were randomly divided into test group（n=16） and control group（n=16）. L-carnitine was put in the cold crystal cardiac arresting liquid in the test group（10 g/L）, other experimental conditions were the same between two groups. Before operation,at 2,24,72 h after the aortic declamping, venous blood was drawn to test the level of serum ereatine kinase（CK）,CK- MB isozyme,cardiac Troponin I（cTnI）,eardiac Troponin T （cTnT）. Results：The level of CK,CK-MB,cTnT,cTnI in blood samples increased indiffereneely in two groups before operation, increased significantly in two groups after the aortic declamp ing.The increase magnitude of CK,CK-MB in control group was more than test group （P〈0.05）; The increase magnitude of cTnT, cTnI in control group was more than test group at 2,24,72 h after declamping, much more at 2 h （P〈0.01）.Conclusion： L-carnitine improves the service of the energy in myocardium undergoing open cardiac operation under CPB obviously, decreases the damage of the ceils in myocardium effectly and has a good protective effect on myoeardium in patients.