外源性磷酸肌酸在心脏直视术中心肌保护效果的观察

THE PROTECTIVE EFFECTS OF EXOGENOUS CREATINE PHOSPHATE ON MYOCARDIUM DURING OPEN HEART SURGERY

观察外源性磷酸肌酸 (ECP)在心脏直视手术中对心肌保护的临床效果。 47例心脏病需体外循环直视手术患者 ,在心肌保护灌注中 ,按St .Thomas 1号液含与不含ECP分成治疗组和对照组 ,通过临床、生化和形态学指标进行对照研究。结果表明 ,治疗组心脏自动复苏率 82 .6 % ,心律失常的发生率 2 6 .1 % ,所需除颤次数 0 .89± 0 .1 4,而对照组指标分别为 5 4.2 % ,5 8.3%和 1 .37± 0 .1 1 (P <0 .0 5 ) ;心肌酶CPK、CK MB的漏出及再灌注MDA、SOD的生成均少于对照组 ;治疗组缺血末高能磷酸化合物的储备增高 ,对照组明显降低。取材于左室乳头肌及右室心内膜下心肌细胞超微结构观察和线粒体半定量分析 ,表明治疗组缺血后保持了较好的完整性。提示ECP作为晶体停搏液中能量成分对心肌缺血有较理想的保护作用。

To evaluate the protective effect of exogenous creatine phosphate (ECP) on myocardium during open heart surgery by clinical, biochemical and morphologic methods. 47 patients undergoing open heart surgery were randomly divided into a control group who received St.Thomas cardioplegic solution No.1, and a treated group, who received the same solution plus ECP. The incidence of spontaneous recover of rhythm was higher in the treated group (82.6% versus 54.2%, P<0.05) and that of postoperative arrhythmias was lower (26.1% versus 58.3%,P<0.05). The necessity of direct current shocks was reduced in the treated group (0.89±0.14) compared with the control group (1.37±0.11, P<0.05). There were significant differences in serum CPK, CK MB, SOD and MDA levels after operation and myocardial high energy phosphate content was founded during aortic clamping between the groups. Ultrastructural observation and semiquantitative study of the mitochondria of the biopsy samples taken from the left ventricular papillary muscle or the right ventricular endomyocardium showed that ECP afforded safisfactory protection of sarcolemma against ischemic damage. ECP might be an effective adjunct to cardioplegic solution for myocardial protection during complex open heart surgery.