盐酸戊乙奎醚对婴儿体外循环下心脏手术缺血再灌注心肌的保护作用

Protective effect of penehyelidine hydrochloride on myocardium during cardio pulmonary bypass heart surgery in infants

目的观察婴儿体外循环下行心脏手术中,盐酸戊乙奎醚对心肌缺血再灌注损伤的保护作用。方法择期于体外循环下行房间隔、室间隔缺损修补术的先天性心脏病患儿20例,年龄1个月～1岁,美国纽约心脏病学会(NYHA)心功能分级Ⅰ或Ⅱ级,美国麻醉医师学会(ASA)分级Ⅱ级。随机分入对照组和盐酸戊乙奎醚组。盐酸戊乙奎醚组患儿于麻醉诱导时静脉注射盐酸戊乙奎醚0.05mg/kg,对照组患儿静脉注射相同容量的0.9%氯化钠注射液。分别于手术前24h(T1)、术后1h(T2)及术后24h(T3)采集患儿静脉血检测血清心肌肌钙蛋白T(cTnT)和心肌酶谱[天门冬氨酸转氨酶(AST)、肌酸激酶(CK)、CK同工酶(CK-MB)、羟丁酸脱氢酶(HBDH)、乳酸脱氢酶(LDH)]水平。分别于主动脉阻断20min及主动脉开放20min时剪取小量未被钳夹的右心耳的心肌组织,经苏木精-伊红(HE)染色,在光学显微镜下观察其结构改变并拍摄照片。结果对照组和盐酸戊乙奎醚组在T2、T3时间点的血清CK、CK-MB、AST、HBDH、LDH和cTnT水平均显著高于同组T1时间点(P值均<0.05),盐酸戊乙奎醚组在T2、T3时间点的血清CK、CK-MB、AST、HBDH、LDH和cTnT水平均显著低于对照组同时间点(P值均<0.05)。盐酸戊乙奎醚组的心肌组织形态较对照组显著改善。结论预先静脉注射0.05mg/kg盐酸戊乙奎醚,可降低体外循环后血清cTnT及心肌酶谱水平,减轻心肌损伤,对缺血再灌注心肌有一定的保护作用。

Objective To evaluate the protective effects of penehyclidine hydrochloride on myocardium ischemia reperfusion injury during cardio pulmonary bypass （CPB） heart surgery in infants. Methods Twenty New York Heart Academy （NYHA） heart function I or II, American Society of Anesthesiologists（ASA） II, 1 month to 1 year pediatric patients undergoing congenital atrial or ventricular septal defect repair, were randomized into group P and group C （control group）. The infants received 0. 05 mg/kg Penehyclidine Hydrochloride or the same volume of Sodium Chloride intravenously during anesthesia induction in group P and C, respectively. The venous blood samples were drawn for serum concentration of troponin （cTnT） and myocardium zymogram （aspartate amino transferase EAST,, creatine kinase [CK], CK-MB, hydroxbutyrate dehydrogenase [HBDH], lactic acid dehydrogenase [LDH]） analysis pre-operatively, 1 h and 24 h postoperatively. Myocardium of the right atrium was sampled 20 rains after aortic occlusion and aortic patefaction for HE staining and structure analysis with 20 x 10 times high power microscope. Results The serum concentration of cTnT and myocardium zymogram （AST, CK, CK-MB, HBDH, LDH） at T2 and T3 were significantly higher than those at T1 in both groups （all P 〈 0.05）. The serum concentration of cTnT and myocardium zymogram were significantly lower in group P compared with those in group C at T2 and T3 （all P〈0. 05）. The microstructure of heart tissues in group P was better than that in group C. Conclusion Penehyclidine Hydrochloride 0.05 mg/kg injected intravenously has myocardium protection function against ischemia reperfusion injury during CPB operations in infants.