腺苷预处理对心脏直视手术心肌保护作用的临床研究

Clinical study on myocardioprotective effects of adenosine preconditioning in patients undergoing open heart surgery

目的 探讨腺苷预处理对心脏直视手术的心肌保护效果。方法 将 30例择期心脏瓣膜置换术患者随机分成治疗组和对照组 ,治疗组在开心术前实施腺苷预处理。观察血清心肌肌钙蛋白T(cTnT)、磷酸肌酸激酶同工酶 (CK MB)、血浆丙二醛 (MDA)、心肌三磷酸腺苷 (ATP)、能量储备(EC)及心肌超微结构 (线粒体计分 )的变化。结果 主动脉开放后 30min ,治疗组cTnT为 ( 0 .42±0 .1 8) μg/L、CK MB为 ( 35.42± 1 5.87)U/L、MDA为 ( 4 .2 8± 0 .35)mmol/L升高值均明显低于对照组 [( 1 .1 6± 0 .32 ) μg/L、( 56.2 6± 1 6.36)U//L、( 6.37± 2 .46)nmol/L(P <0 .0 5) ];治疗组ATP含量( 1 5.86± 3.51 ) μmol/g干重和EC值 0 .4857± 0 .0 578均明显高于对照组 [( 6.2 5± 2 .79) μmol/g干重、0 .2 992± 0 .0 4 1 9(P <0 .0 1 ) ];治疗组线粒体计分 0 .860 2± 0 .2 381明显低于对照组 2 .740 6±0 .9792 ,(P <0 .0 1 )。

Objective\ To investigate the myocardioprotective effects of adenosine preconditioning in patients undergoing open heart surgery.Methods\ Thirty patients with valve replacement were randomly divided into 2 groups: treated and control. Adenosine preconditioning was elicited in the treated group before the cardiopulmonary bypass. The changes in serum cTnT, CK MB and MDA were observed. ATP content and EC in myocardium were measured. The change in myocardial ultrastructure (mitochondria calculating) was studied. Results\ At 30 min after opening the aorta, the cTnT (0.42±0.18) ug/L, CK MB (35.42±15.87) U/L and MDA (4.28±0.35) nmol/L in the treated group were significantly lower than in the control group [(1.16±0.32) μg/L, (56.26±16.36) U/L, (6.37±2.46) nmol/L, respectively, ( P <0.05)], while the myocardial ATP content (15.86±3.51) μmol/g·dry wt and EC value 0.485?7 ±0.057?8 were much higher than in the control group [(6.25±2.79) μmol/g·dry wt, 0.299?2± 0.041?9 , ( P <0.01)]. The mitochondria calculating in the treated group 0.860?2±0.238?1 was much lower than in the control group 2.740?6±0.979?2( P <0.01). Conclusion\ Adenosine preconditioning can reduce ischemic reperfusion injury.\;