不同剂量盐酸戊乙奎醚对体外循环冠脉搭桥手术患者心肌保护作用

Myocardial protective effects of different doses hydrochloric penehyclidine on patients undergoing coronary artery bypass grafting with cardiopulmonary bypass

目的 比较两种不同剂量盐酸戊乙奎醚对体外循环下行冠脉搭桥手术患者心肌保护作用.方法 2011年5月至2013年5月择期行冠脉搭桥手术患者75例,随机分成3组：对照组（25例）,给予等量生理盐水;小剂量组（25例）,戊乙奎醚 0.05 mg/kg;大剂量组（25例）,戊乙奎醚0.1 mg/kg.比较三组冠脉搭桥手术患者不同时间点的心肌肌钙蛋白I（cTnI）、肌酸磷酸激酶同工酶MB（CK-MB）、肌酸激酶（CK）、谷草转氨酶（AST）、α-羟丁酸脱氢酶（α-HBDH）、乳酸脱氢酶（LDH）浓度的变化.结果 三组患者cTnI、CK-MB、CK、AST、α-HBDH、LDH浓度,主动脉开放后1 h（T1）及主动脉开放后24 h（T2）与麻醉诱导前（T0）相比明显升高,差异均有统计学意义（P〈0.05）;T1、T2时间点组间比较,戊乙奎醚大、小剂量组低于对照组,差异有统计学意义（P〈0.05）,戊乙奎醚大剂量组与小剂量组相比差异无统计学意义（P＆gt;0.05）.结论 盐酸戊乙奎醚对体外循环冠脉搭桥手术患者具有心肌保护作用,安全性好,值得临床推广和应用,剂量上大剂量组并不优于小剂量组.

Objective To compare the myocardial protective effects with different doses of hydrochloric penehyclidine on patients undergoing coronary artery bypass grafting with cardiopulmonary bypass （CPB）. Methods Patients undergoing coronary artery bypass grafting with CPB were randomly divided into three groups, control group（n=25）, low-dose group（n=25）, and high-dose group（n=25）, then normal saline, penehyclidine （0.05 mg/kg）, penehyelidine（0.1 mg/kg） were given respectively. Concentrations of blood biochemical agents were observed at 1 hour after aortic deelamping（T1 ） and 24 hours after aortic declamping（T2）, which included troponin I （cTnI）, creatine kinase isoenzyme MB （CK-MB）, ereatine kinase （CK）, aspartate aminotransferase （AST）, α- hydroxybutyrate acid dehydrogenase（α-HBDH）, lactate dehydrogenase（LDH）. Results In each group, the concentration of cTnI, CK-MB, CK, AST, α-HBDH, LDH at T1 and T2 were significantly higher than those before induction of anesthesia（T0）（P〈0.05）. The concentration of these blood agents were significantly lower in low-close penehyclidine group and high-dose penehyclidine group than those in control group（P〈0.05 ）. There was no signifi- cant concentration difference of those blood agents between low dose and high-dose penehyclidinc group （P〉0.05）. Conclusion Both low and high dose hydrochloric penehyelidine have myocardial protective effects on patients undergoing coronary artery bypass grafting with cardioptdmonary bypass at I and 24 hour after aortic declamping, and there is no significant difference between these 2 groups.