磷酸肌酸对心脏瓣膜置换患者围术期心肌保护和血流动力学的影响

Effect of creatine phosphate on myocardium protecting and hemodynamics in patients with heart valve replacement during peri-operative period

目的观察外源性磷酸肌酸(exogenous creatine phosphate,ECP)对体外循环心脏瓣膜置换围术期患者心肌保护和血流动力学的影响。方法回顾性分析90例体外循环行心脏瓣膜置换患者的临床资料,分为对照组和ECP组各45例,观察两组自动复跳情况,术后12 h内心律失常的发病率,血清肌酸激酸同工酶(CK-MB)、肌钙蛋白I(cTnI)和血流动力学的变化。结果主动脉开放后,ECP组心脏自动复跳率显著高于对照组,差异有统计学意义(89%vs.68%,P<0.05)。手术结束后12 h内心律失常的发病率ECP组低于对照组,差异有统计学意义(26%vs.38%,P<0.05)。在开放升主动脉10 min、手术结束、术后6 h、术后12 h,ECP组各时间点的血清肌酸激酶同工酶和肌钙蛋白I浓度均比对照组低,差异有统计学意义(P<0.05)。切皮前的ECP组心指数高于对照组,差异有统计学意义[(2.2±0.6)L.min-1.m-2 vs.(1.6±0.5)L.min-1.m-2,P<0.05],切皮前ECP组的体循环阻力指数和肺循环阻力指数均低于对照组,差异有统计学意义[(2 721.0±841.9)dyne.s-1.cm-5.m-2 vs.(3 315.0±978.0)dyne.s-1.cm-5.m-2,P<0.05;(188.5±57.0)dyne.s-1.cm-5.m-2 vs.(238.3±90.2)dyne.s-1.cm-5.m-2,P<0.05]。结论 EPC用于体外循环心脏瓣膜置换患者,有确切的心肌保护作用和能维持稳定的血流动力学状态。

Objectives To evaluate the effect of of exogenous creatine phosphate（ECP） on myocardium protocting and hemodynamics in patients with heart valve replacement.Methods We retrospectively analyzed the clinical data of 90 patients with heart valve replacement and divided them into control group（n=45）and ECP group（n=45） by randomized double blind method.Automatic recovery rate of heart beats after cardiac resuscitation,changes of postoperative arrhythmia rate,postoperative serum MB isoenzyme of creatine kinase（CK-MB）,cardiac treponin I（cTnI） and hemodynamics in 12 h between two groups were compared.Results The automatic recovery rate of heart beats was significantly higher in ECP group than that in control group（89% vs.68%,P0.05）.Postoperative arrhythmia rate within 12 h was significantly lower in ECP group than that in control group（26% vs.38%,P0.05）.Serum concentrations of CK-MB and cTnI were lower in ECP group than those in control group at clamp off of aorta,end of operation,6 h after operation,12 hour after operation respectively（all P0.05）.The preoperative cardiac index was higher in ECP group than in control group[（2.2±0.6）L·min-1·m-2 vs.（1.6±0.5）L·min-1·m-2,P0.05].Systemic vascular resistance index and pulmonary vascular resistance index were lower in ECP group than in control group[（2 721.0±841.9）dyne·s-1·cm-5·m-2 vs.（3 315.0±978.0）dyne·s-1·cm-5·m-2,P0.05;（188.5±57.0）dyne·s-1·cm-5·m-2 vs.（238.3±90.2）dyne·s-1·cm-5·m-2,P0.05].Conclusions EPC shows positive effects on protecting myocardium and makes hemodynamics stable in patients with heart valve replacement.