磷酸肌酸钠复合氨甲环酸对非体外循环冠状动脉旁路移植术患者心肌和血液保护作用的研究

The myocardial and blood protectivie effects of creatine phosphate sodium combined with tranexamic acid in off-pump coronary artery bypass grafting

目的 研究在非体外循环下行冠状动脉旁路移植术（off-pump coronary artery bypass grafting,OPCABG）中应用磷酸肌酸钠及氨甲环酸对缺血心肌的保护及血液保护作用.方法 将拟行OPCABG术的冠心病患者280例按完全随机法分为4组,每组70例,实验组、磷酸肌酸钠组、氨甲环酸组和对照组.记录各组间胸液引流量、围术期心肌酶谱变化、输血量等以观察磷酸肌酸复合氨甲环酸对于OPCABG患者的心肌及血液保护效果.结果 通过实验组和其他各组比较,实验组OPCABG患者在术后6、12、24、48、72 h肌酸激酶同工酶（creatine kinase-MB,CK-MB）血浆浓度（15±6）、（14±5）、（16±10）、（15±6）、（13±6）U/ml、肌钙蛋白（cardiac troponinic,cTnI）血浆浓度（2.35±1.53）、（2.72±1.46）、（2.64±1.32）、（1.16±0.76）、（0.48±0.24）mg/L明显低于其他组;各时间点胸液引流量（246±56）、（420±82）、（680±114）、（725±126）、（730±130）ml,及输血例数（5/70）也明显低于其他组（P＜0.05）.结论 在OPCABG中,磷酸肌酸钠及氨甲环酸能够减少术后出血及因失血引起的并发症,对心肌有一定的保护作用,磷酸肌酸钠复合氨甲环酸用于OPCABG术则能起到良好的心肌保护和血液保护作用.而不增加手术死亡率及术后并发症的发生率.

Objective To investigate whether the supplement of creatine phosphate sodium and tranexamic acid to cardioplegic solutions can improve myocardial protection and blood conservation in off-pump coronary artery bypass graft（OPCABG）.Methods 280 patients undergoing OPCABG were randomly assigned to experimental group （CP with TA group, n=70 ） , creatine phosphate sodium group （CP group, n=70）, tranexamic acid group （TA group, n=70） and control group （n=70）. Before BACG,creatine phosphate sodium （ 100 mg/kg） combined with tranexamic acid （30 mg/kg）, creatine phosphate sodium （ 100 mg/kg）,tranexamic acid （30 mg/kg）, and equal volume of normal saline were given intravenously in each group respectively. Venous blood samples were taken preoperatively, and at 0, 6, 12, 24, 48, 72 h, 7 d postoperatively to analyze creatine kinase isoenzyme （CK-MB）, troponin （cTnI） ; Meanwhile, the amount of cumulative chest fluid drainage and inotropic agent and blood transfused were also recorded. Results The plasma concentrations of CK-MB in experimental group at 6, 12, 24, 48, 72 h postoperatively （15±6）, （14±5）, （16±10）, （15±6） and （13±6） U/ml and the plasma concentrations of cTnI（235±1.53）, （2.72±1.46）, （2.64±1.32）,（1.16±0.76） and （0.48±0.24） mg/L were significantly lower than those in group CP, group TA and control group （P〈0.05）. The amount of postoperative cumulative chest fluid at 6, 12, 24, 48, 72 h were （246±56）, （420±82）, （680±114）, （725±126） and （730±130） ml drainage and blood transfuison in experimental group （5/70） were also significantly lower than those in other groups （P〈0.05）. Conclusion For patients undergoing OPCABG, creatine phosphate sodium combined with tranexamic acid plays an important role in myocardial protection and blood conservation without increasing the surgical mortality and the incidence of postoperative complications.