门冬氨酸钾镁在不停跳冠状动脉旁路移植术中对心肌的保护作用

The protective effect of potassium magnesium aspartate on myocardium for patients undergoing off-pump coronary artery bypass graft

目的:门冬氨酸钾镁是门冬氨酸钾盐和镁盐组成的混合盐,可迅速有效地提高细胞内钾镁离子含量,本实验旨在研究门冬氨酸钾镁在不停跳冠状动脉旁路移植术(OPCABG)中对心肌的保护作用。方法:择期行OPCABG患者60例,随机分为门冬氨酸钾镁组(A组)及普通氯化钾对照组(B组)。A组将门冬氨酸钾镁注射液(潘南金)100 mL加入0.9%氯化钠液150 mL中;B组使用15%氯化钾注射液15 mL加入0.9%氯化钠液250 mL中,于气管插管后经中心静脉持续输注,必要时两组可酌情输注15‰氯化钾或利尿剂以维持术中血浆钾离子浓度4.0～5.0 mmol/L。监测所有患者的临床效果和术后心律失常的发生率;并分别在诱导前、术后6 h、24 h及72h抽取患者静脉血测定血浆镁离子浓度、心肌肌钙蛋白Ⅰ(cTnⅠ)和肌酸激酶同工酶(CK-MB)的水平。结果:A组在术后6 h、24 h及72 h的血浆镁离子浓度均高于B组(P<0.05)。两组cTnⅠ和CK-MB水平从术后6 h开始逐渐升高(P<0.05),72 h开始降低。与B组比较,A组在术后6h、24 h和72 h的血浆cTnⅠ和CK-MB明显降低(P<0.05),且术后心律失常的发生率较B组明显降低(P<0.05)。结论:OPCABG中常规应用门冬氨酸钾镁有利于缺血心肌的保护,可减轻术中心肌损伤,预防心律失常,有益于术后心脏功能的早日恢复。

Objective：To investigate whether the intravenous infusion of potassium magnesium aspartate（PMA） have myocardial protective effect for patients undergoing off-pump coronary artery bypass graft（OPCABG）.Methods： Sixty patients underwent OPCABG were divided into two groups randomly（n=30）： group A and group B.Group A received PMA,and group B received potassium chloride continuously by central venous cannula during anesthesia,also,the serum potassium level was maintained between 4.0 and 5.0mmol/L for all patients.In the meantime the cTnⅠ,CKMB and serum magnesium were measured before induction,at 6h,24h,and 72h after operation respectively.The incidence of cardiac arrhythmia in two groups was recorded at the same time either.Results： Compared to group B,the plasma magnesium in group A was higher at postoperative 6h,24h and 72h.The plasma concentration of cTnⅠ and CKMB in group A were significantly lower than that of group B at postoperative 6h,24h and 72h.The incidence of perioperative cardiac arrhythmia was also lower in group A compared with group B.Conclusion： PMA may have myocardium protective effect for patients undergoing OPCABG,and can reduce the incidence of perioperative cardiac arrhythmia after operation.