阿魏酸钠和曲美他嗪联合预处理对心肌缺血再灌注损伤的保护作用

The effect of Sodium Ferulate and Trimetazidine combined pre-condition for myocardial ischemia-reperfusion injury

目的观察阿魏酸钠和曲美他嗪联合预处理对体外循环(ECC)心肌缺血再灌注损伤的保护作用。方法 30例行心脏瓣膜置换术患者,随机分为曲美他嗪(单纯治疗)组(n=15);阿魏酸钠和曲美他嗪(联合治疗)组(n=15)。分别于手术前(T0)、术毕(T1)、术后6 h(T2)、术后24 h(T3)检测肌酸激酶同工酶(CKMB)、心肌肌钙蛋白I(cTnI)、丙二醛(MDA)、超氧化物歧化酶(SOD)。同时记录心脏复跳、术后正性肌力药物的应用情况。结果 CKMB和cTnI两组均明显升高,但T1、T2、T3时联合治疗组低于单纯治疗组(P<0.05);MDA两组各时点均较术前明显升高,联合治疗组低于单纯治疗组(P<0.05);SOD在术后持续下降,但单纯治疗组在各时点下降更为显著(P<0.05);术后多巴胺用量,联合治疗组明显低于单纯治疗组(P<0.05)。结论阿魏酸钠和曲美他嗪联合治疗可以明显减轻心肌缺血再灌注损伤,具有较好的心肌保护作用,其保护作用优于单纯治疗组。

Objective To observe the protective effect of Sodium Ferulate （SF） and Trimetazidine （TMZ） combined pre -condition on myocardial ischemia - reperfusion injury in extracorporeal circulation. Methods Thirty patients underwent cardiac valve replacement were divided into two groups in random： TMZ group （n = 15） and TMZ combined with SF group （n = 15）. Creatine isoenzyme （CKMB）, cardiac troponin Ⅰ （cTnI）, malondialdehyde （MDA） and superoxide dismutase （SOD） were measured at preoperation （T0）, termination of operation （T1）, six hours after operation （T2） and twenty- four hours after operation （T3）. The condition of cardiac - rebeating and application of cardiotonic agents were recorded at the same time. Results Both CKMB and cTnI were elevated in two groups at T1,T2 and T3, however in contrast with the TMZ group, they were lower in the combined-therapy group （ P 〈0.05） ; MDA was all obviously higher than pre - operation in both of two groups, however MDA in the combined - therapy group was lower than in the TMZ group at the time of operation termination, six hours after operation, and twenty - four hours after operation （ P 〈 0.05 ） ; SOD was decreased after operation in two group, but it was obviously lower in the TMZ group than in the combined - therapy group （ P 〈 0.05） ; meanwhile, the postoperative dosage of dopamine administration in the combined - therapy group was obviously lower than that in the TMZ group （ P 〈 0.05）. Conclusion Combined using of SF and TMZ can obviously decrease the injury of myocardial ischemia - reperfusion injury and has more effective protective effect for myocardium.