L-精氨酸和腺苷联合应用抗心肌缺血再灌注损伤的临床研究

Clinical study in anti myocardial ischemia reperfusion injury of combined using L-arginine and adenosine

目的探讨左旋精氨酸和腺苷联合应用对婴幼儿法洛四联症根治术心肌缺血再灌注损伤的保护作用。方法拟行心内直视手术的婴幼儿法洛四联症患者40例,随机分为对照组(A组)、左旋精氨酸组(B组)、腺苷组(C组)和联合用药组(D组),每组各10例。A组常规心肌保护液,B组于给予含2.5 g/L左旋精氨酸心肌保护液,C组给予含2.5 g/L腺苷心肌保护液和D组给予含左旋精氨酸和腺苷两种药物心肌保护液。分别于主动脉插管时及主动脉开放后30 min、2 h和6 h检测血浆心肌肌钙蛋白(IcTnI)、肌酸激酶同工酶(CK-MB)。结果与对照组比较,B、C和D组血浆cTnT、CK-MB显著降低。且D组与B组、C组比较可显著降低血浆CK-MB。结论左旋精氨酸和腺苷联合应用对婴幼儿法洛四联症根治术缺血再灌注损伤心肌有良好的保护作用,联合应用优于两药单独应用。

[ Objective ] To investigate the myoprotective effect of the blood Cardioplegic Solution with L-arginine and Adenosine in infants with tetralogy of Fallot on myocardial isehemia reperfusion injury. [ Methods ] Open heart operation were performed in infants with tetralogy of Fallot, 40 patients were randomly divided into control group （group A）, arginine group （group B）, adenosine group （group C） and combination group （D group）, 10 cases in each group. Group A conventional myocardial protective liquid, in group B containing 2.5 g/L arginine myocardial protec- tive liquid, C group containing 2.5 g/L adenosine myocardial protective liquid and group D containing arginine and adenosine two drugs myocardial protective liquid. In aortic cannulation and the aortic opening after 30 rain, 2 h and 6 h plasma cardiac troponin I （cTnI）, creatine kinase isoenzyme （CK-MB） were detected. [Results] Compared with control group, group B, C and D plasma cTn[, CK-MB significantly reduced. Then compared with group B, C, D groups plasma CK-MB significantly decreased. [ Conclusions ] L-arginine and adenosine has a good protective ef- fect on infants with tetralogy of Fallot myocardial ischemia reperfusion injury, combined application was better than the two drugs used separately.