环磷腺苷葡胺预处理对瓣膜置换术患者心肌的保护作用

Myocardial protective effect of meglumine adenosine cyclophosphate preconditioning in patients undergoing cardiac valve replacement with cardiopulmonary bypass

目的评价环磷腺苷葡胺预处理对瓣膜置换术患者心肌的保护作用。方法择期行体外循环心脏瓣膜置换术患者60例，性别不限，年龄28-64岁，ASA分级Ⅱ级或Ⅲ级，心功能分级Ⅱ级或Ⅳ级，随机分为对照组（c组）和环磷腺苷葡胺预处理组（M组）各30例。M组在麻醉诱导后从颈内静脉输注环磷腺苷葡胺2mg／kg，C组给予等量生理盐水。于麻醉诱导前（T0，基础状态）、主动脉开放后30min（T1）、术后6h（T2）、24h（T3）记录两组患者HR、MAP、CVP等血流动力学指标，并取静脉血测定心肌肌钙蛋白I（cTnI）浓度和肌酸激酶同工酶（CK-MB）活性；术前1d和术后7d行心脏彩超了解患者左心室射血分数（LVEF）、心脏指数（CI）。结果与c组比较，M组主动脉开放后各时点血流动力学指标差异无统计学意义（P〉0．05），cTnI浓度和CK-MB活性降低（P〈0．05）。两组间LVEF和CI术前比较差异无统计学意义（P〉0．05），术后7d时M组LVEF和cI高于C组（P〈0．05）。结论环磷腺苷葡胺预处理有利于瓣膜置换术患者左心功能的恢复，具有心肌保护作用，其机制可能与降低cTnI浓度和CK．MB活性有关。

Objective To evaluate the myocardial protective effect of meglumine adenosine cyclophosphate （MAC） preconditioning in patients undergoing cardiac valve replacement with cardiopulmonary bypass. Methods Six- ty patients （ASA grade II or IV, NYHA class 1I or llI）, aged 28-64, scheduled for cardiac valve replacement with car- diopulmonary bypass, were randomly divided into control group （group C） and MAC preconditioning group （group M） （n=30 each）. In group M, MAC 2 mg/kg was infused via central vein after induction of anesthesia. In group C same volume normal saline was infused instead of MAC. HR, MAP and CVP were determined, and blood samples were obtained for determination of plasma concentrations of cardiac troponin-I （cTnI） and activities of CK-MB before induction of anesthesia （To, baseline）, at 30 min after aortic unclamping （%） and at 6 h （T2）, 24 h （%） after operation. Left ventricular EF and CI were measured before operation and at 7 days after operation. Results There was no significant difference in the hemodynamic parameters between the two groups. The plasma concentrations of cTnI and activity of CK-MB were significantly lower, at 30 min after aortic unclamping and at 6 h, 24 h after operation in group M than those in group C （P〈0.05）. LVEF and CI between two groups were not significantly different before surgery. LVEF and CI were significantly higher at 7 days after operation in group M than those in group C （P〈0.05）. Conclusion MAC precondition can recover cardiac function and protect myocardium, which mechanism is related to decreasing the plasma concentrations of cTnI and the activity of CK-MB.