L-精氨酸在婴幼儿室间隔缺损修补术心肌保护中的作用

EFFECTS OF L -ARGININE ON INFANT MYOCARDIAL ISCHEMIA REPERFUSION INJURY DURING REPAIR OF VENTRICULAR SEPTAL DEFECT

目的探讨改良心肌保护液对婴幼儿心肌保护作用。方法婴幼儿室间隔缺损修补术30例,随机分为试验组15例(改良心肌保护液),对照组15例(单纯冷晶体停搏液),分别观察主动脉开放后心脏自动复跳率,机械辅助通气时间和ICU停留时间,术后正性肌力药物辅助情况,并于转流前、主动脉开放后30min,术后3、24、72h分别抽血测定肌酸肌酶(MB isoenzyme of creatine kinase,CK-MB)、肌钙蛋白T(cardiac troponin T,cTnT)。结果试验组心脏自动复跳率明显高于对照组(P<0.05),术后机械辅助通气时间和ICU停留时间、多巴胺用量均低于对照组(P<0.05),在主动脉开放后30min、术后3、24、72h血浆CK-MB、cTnT水平明显降低,与对照组相比,差异有统计学意义(P<0.01)。结论加入L-精氨酸的改良心肌保护液对婴幼儿未成熟心肌具有明显保护作用。

Objective To investigate the protective effects of L- arginine （L- Arg） on myocardial ischemia reperfusion injury during open heart surgery under eardiopuhnonary bypass （CPB） . Methods Thirty patients with congenital ventricular septal defect were randomly divided into L -Arg group（ n = 15） received L- Arg 4 g/L in eardioplegie solution and control group （n = 15 ） received saline solution in the same mode. Before aortic - clamping , 30 min after opening aorta, 3 , 24 and 72 h after termination of CPB, blood samples in artery were taken for the measurements of cardiac troponin T （ cTnT） and MB isoenzyme of creatine kinase （CK -MB ） . Results The L - Arg group could significantly lower the increase of cTnT and CK - MB . Postoperatively duration of mechanical assistant ventilation and detention time in ICU Were shorter in＇the L- Arg group, and the usage amount of dopamine was less. Conclusion L-Arg has notable protective effect on ischemia reperfusion myocardium in the immarture heart during open heart surgery under CPB.