山莨菪碱对心脏瓣膜置换术中心肌再灌注损伤的作用

Effect of Anisodamine on Myocardial Reperfusion Injury

目的 :观察体外循环心脏瓣膜置换术中山莨菪碱对心肌再灌注损伤的作用。方法 :18例体外循环心脏瓣膜置换术的病人随机分为 2组 ,每组 9例。观察组在再灌注前静脉注入山莨菪碱 0 .2 5 m g/ kg,对照组给予等量生理盐水。观察再灌注前后血中乳酸脱氢酶 (L DH)、肌酸激酶 (CK)以及丙二醛 (MDA)含量的变化 ,并比较 2组体外循环后心功能的恢复情况。结果 :观察组在再灌注后血清 L DH、CK含量虽仍较再灌注前高 ,却低于对照组 ,2组间的差别具有显著意义 (P <0 .0 5 ) ;对照组在再灌注后血浆 MDA明显升高 (P <0 .0 5 ) ,而观察组与再灌注前比 ,差别无显著性意义 (P >0 .0 5 ) ;体外循环后心功能恢复情况观察组好于对照组。结论 :再灌注前给予山莨菪碱可在一定程度上减轻心肌再灌注损伤 。

Objective: Our purpose was to study the effect of anisodamine on the injury of myocardium after myocardial ischemia reperfusion. Methods: Eighteen patients (ASA grade Ⅱto Ⅲ) scheduled for valve replacement, were randomly divided into 2 groups during extracorporeal circulation. Anisodamine (0.25 mg/kg) was given intravenously in the anisodamine group before reperfusion. Equivalent volumes of normal saline were administered in the control group. The central venous blood samples were collected at different time after ischemia and reperfusion. We then measured the concentrations of lactic dehydrogenase (LDH), creatine kinase (CK), and malondiadehyde (MDA) with biochemical methods. Results: The levels of serum LDH, CK, and plasma MDA increased significantly in the control group during ischemia and reperfusion. In the anisodamine group, the levels of serum LDH and CK increased. But the values were lower at corresponding time than those in the control group (P<0.05) during reperfusion. The plasma level of MDA unchanged in the anisodamine group during ischemia and reperfusion. The postoperative cardiac function recovered much more better in the anisodamine group. Conclusion: Anisodamine can reduce the degree of reperfusion injury. A certain protective effect on myocardial ischemia reperfusion injury exsists during valve replacement.