磷酸肌酸钠用于心肌缺血患者围手术期的疗效评价

Curative effect evaluation of sodium phosphocreatine on patients with myocardial ischemia during perioperative period

目的观察磷酸肌酸钠对心肌缺血患者围手术期血流动力学、人心肌脂肪酸结合蛋白（hFABP）及心肌肌钙蛋白Ⅰ（cTnⅠ）的影响。方法选择术前心电图检查提示有广泛心肌缺血患者40例，ASA分级Ⅱ-Ⅲ级，采用随机数字表法分为磷酸肌酸钠组和对照组，每组20例。两组均常规术前准备，磷酸肌酸钠组手术前3d加用磷酸肌酸钠2州，至手术当日麻醉诱导前。分别记录手术前3d（T0）、麻醉诱导前即刻（T1）、气管插管后即刻（T2）、气管拔管后即刻（T3）血流动力学参数：平均动脉压（MAP）、心率、心排出量（CO）、每搏指数（SI）、肺血管阻力（PVR）；各时间点分别抽静脉血测定hFABP及eTnI的含量。结果两组心率在Tn—T1比较差异无统计学意义（P〉0．05），磷酸肌酸钠组T1-T3MAP、CO、SI明显高于对照组（P〈0．05），PVR、hFABP及eTnI明显低于对照组（P〈0．05）。磷酸肌酸钠组术中心律失常发生率[20％（4／20）]明显低于对照组[45％（9／20）]（P〈0．05）。结论心肌缺血患者围手术期应用磷酸肌酸钠对心肌有良好的保护作用。

Objective To observe the influence of sodium phosphocreatine on the hemodynamics, human heart fatty acid binding protein （hFABP）,cardiac troponin Ⅰ（cTnⅠ） during perioperative period. Methods Forty patients （ASA grade Ⅱ to Ⅲ ） with extensive myocardial ischemia diagnosed by preoperative electrocardiogram were divided into two groups ： sodium phosphocreatine group （ group A ） and control group （group B ） with 20 cases each by random digits table. Both groups underwent routine preoperative preparation and group A were given sodium phosphocreatine 2 g/d till anesthesia induction immediately in the operation day. Hemodynamic parameters including mean artery pressure （MAP）,heart rate （HR）,cardiac output （CO）, stroke index （SI） and pulmonary vascular resistance （PVR） were recorded respectively at 3 d before treatment （T0）, anesthesia induction immediately before （T1）, tracheal intubation immediately after （T2）, tracheal extubation immediately after （T3）. And blood hFABP and cTnI levels were detected. Results Compared with group B, there was no significant difference in HR of group A at To to T3 （P 〉 0.05 ）. MAP, CO, SI at T1 to T3 of group A were significantly higher than those of group B （P 〈 0.05 ） ; whereas PVR, blood hFABP and cTnI levels were lower than those of group B （P 〈 0.05 ）. The incidence of arrhythmogenesis of group A [20%（4/20）] was lower than that of group B [45%（9/20）]（P〈0.05）. Conclusion Sodium phosphocreatine has good protective effect on the myocardium in the patients with myocardial ischemia during perioperative period.