磷酸肌酸钠停搏液对心功能不全瓣膜病患者的心肌保护作用

Myocardial protective effects of cardioplegic solution enriched with creatine phosphate sodium in cardiopathie valvulaire with cardiac insufficiency

目的:探讨磷酸肌酸钠(CP)对心功能不全瓣膜病患者术后心肌保护作用。方法:将82例择期行瓣膜置换术或成形术的慢性心功能不全患者随机分为两组:(1)对照组,常规使用4∶1含血心脏停搏液;(2)外源性磷酸肌酸钠组(CP组),在心脏停搏液中加入注射用磷酸肌酸钠。于转机前及术后24h分别采血测定心肌酶谱,记录术后血管活性药物使用及机械通气等情况。结果:CP组的心肌酶谱各指标均显著低于对照组(P<0.05);心脏自动复跳率明显高于对照组(P<0.05);机械通气时间也较对照组缩短(P<0.05);血管活性药物应用量均较对照组小(P<0.05)。结论:心脏停搏液中加入磷酸肌酸钠有明显的心肌保护作用,有利于心功能不全瓣膜病患者术后心功能恢复。

Abstract：Objective To investigate the effect of creatine phosphate sodium on myocardinm protecting in valvular heart disease with cardiac insufficiency after radical operation and its clinical value.Methods 82 patients（valvular heart disease suffering from cardiac insufficiency were going selective surgery by Valve replacement or valvoplasty） were randomly divided into two groups：group A using sanguineous 4：1 crystalloid solution,and group B using the sanguineous 4：1 crystalloid solution but added with 10mmol/L exogenous creatine phosphate sodium.Blood samples were collected before the extracorporeal circulation and 24hours after the operation.Analysis of myocardial enzymes was made for detection ,and the duration of mechanical ventilation and the use of vasoactive drugs were also noted down.RESULTS The data collected from the analysis of myocardial enzymes demostrated that in group B was lower than that in group A; The automatic recovery rate of heart beat in group B was much higher than that in group A and the duration of mechanical ventilation was also apparently shorter in group B than in group A; The dosage of vasoactive drugs（dopamine、epinephrine）applied after operation was much smaller in group B than that in group A.CONCLUSION Cardioplegic soludtion enriched with creatine phosphate sodium is an effective composition which can significantly improve cardiac function recovery of valvular heart disease sufering from cardiac insufficiency.