磷酸肌酸钠在婴幼儿心内直视手术中的心肌保护作用

Myocardial protective effects of creatine phosphate (CP) in infants undergoing open heart surgery

目的:探讨磷酸肌酸钠(CP)在婴幼儿心内直视术中的心肌保护作用及其临床应用价值。方法:选择40例房间隔缺损(ASD),或室间隔缺损(VSD)的先天性心脏病患儿,随机分为CP停搏液组和冷晶体高钾停搏液组。2组患儿均于体外循环(CPB)前、主动脉阻断10 min、转流结束后,术后2 h和术后12 h,抽取中心静脉血2 mL,测肌酸激酶-同工酶(CK-MB)和肌钙蛋白I(cTnI)的浓度;分别记录临床观察指标(体外循环时间、主动脉阻断时间、术后呼吸机辅助时间、手术结束后及术后12 h多巴胺用量)。结果:CP组临床观察指标优于对照组(P<0.05);2组CK-MB和cTnI浓度均于主动脉阻断后开始上升,于转流结束后达高峰,与CPB前比较差异有统计学意义(P<0.01)。2组间比较,实验组主动脉阻断后各时点升高的幅度低于对照组,差异有统计学意义(P<0.05)。结论:婴幼儿心内直视术中,应用含CP的停搏液对婴幼儿心肌具有良好的保护作用。

Objective：To investigate the myocardial protective effects of creatine phosphate（CP） in infants undergoing open heart surgery and clinical practical values.Methods：Forty infant patients with ASD（atrial septal defect）or VSD（ventricular septal defect）were randomly divided into CP and hypothermal crystal hyperkalium cardioplegic solution group.Creatine kinase-isoenzymes（CK-MB）,cardiac troponin-I（cTnI）and clinical items（cardiopulmonary bypass,CPB time,aortic off-clamping time,mechanical ventilation time,dopamine dosage immediately after operation and 12 h after operation）were measured in each group before CPB,at 10 min after the aorta off-clamping,after CPB and at 2,12 h after operation respectively.Results：Clinical items of CP group were better than that of control group（P0.05）.The level of CK-MB and cTnI rise after aortic off-clamping,and reached the peak after CPB.There were statistic differences between pre-CPB and after CPB in each group（P0.01）.CK-MB and cTnI level of CP group were lower than that of control group.There were statistic differences between two groups（P0.05）.Conclusion：CP cardioplegic solution can enhance infants myocardial protection,which undergoing open heart surgery.