心内直视手术时1,6-二磷酸果糖保护心肌作用的临床研究

Protective effect of 1, 6-fructose-diphosphate (FDP) in open heart operation

目的 研究探讨1,6-二磷酸果糖(FDP)在心内直视手术时保护心肌的作用。方法 随机将42例成年择期心脏瓣膜置换术患者分为对照组和试验组各21例。两组均采用常规用药,试验组于术前三天开始静脉滴入EDP 250mg·kg^(-1)·d^(-1),分两次滴入,速度(0.5g/min);手术切开心包腔,悬吊心包,建立术野后时点滴给药FDP 5g(0.5g/min),剩余剂量则于二尖瓣替换完毕,缝合房间隔切口之前,约在开放升主动脉前10～15分钟滴入(0.5g/min),维持的至升主动脉开放后10分钟以上。并观察两组的自动复跳率,术后早期心电图,术后早期并发症发生率。阻断升主动脉前,开放后5分钟及10分钟从冠状静脉窦取血2ml测定SOD含量(冠状静脉窦插管);阻断升主动脉前,开放2、4、24、48小时时从中心静脉取血2ml,测定心肌酶(主要为CPK-MB)含量;阻断升主动脉前,开放后10分钟从左心房取心肌标本进行电镜观察。结果 试验组自动复跳率高于对照组,复跳后早期心律失常及术后早期并发症低于对照组(P<0.05);试验组SOD含量(开放5分钟、10分钟)均多于对照组。CPK-MB漏出量均少于对照组(P<0.05),开放升主动脉后10分钟,对照组心肌超微结构有明显缺血、缺氧性改变,试验组变化不大。结论 1,6-二磷酸果糖在心内直视手术中具有明显的心肌保护作用。

Objective To investigate the myocardial protection effects of 1, 6-fructose-diphosphate(FDP) . Methods 42 adult patients with cardiac valve replacement were randomly divided into two groups. In the control group (n = 21), the treatment was common. And in the treated group (n = 21 ),FDP was injected by intravenous drip. Coronary venous sinus blood samples were collected before cross-clamping and 5,10 minutes after aorta opening. Central venous blood samples were collected before cross-clamping and 2, 4, 24, 48 hours after aorta opening. Biopsy samples of the left atrium for electron microscopy were obtained before cross-clamping and 10 minutes after aorta opening. Results (1) The rates of automatically restart were higher in the treated group than in the control group. The control group tends to have more severe jschemia changes of early-postoperative ECG and have higher rates of fibrillation or more early-postoperative complications than the treated group. (2)5,10 minutes after aorta opening,SOD levels were higher in treated groups vs. the control group (P<0.05). (3)2,4,24,48 hours after aorta opening, CPK-MB levels were lower in the treated group vs. the control group(P<0. 05). (4)The changes of myocardial ultrastructure before cross-clamping were similar between the two groups. But 10 minutes after aorta opening , the changes were more severe in the control group than in the treated group. Conclusion 1, 6-fructose-diphosphate has evident protective effect in open heart operation.