主动脉阻断后经主动脉根部注射葛根素注射液对二尖瓣置换术患者心肌损伤的影响

The Effect of Puerarin Injection Through Aortic Root Infused on Myocardial Injury in Patients Undergoing Mitral Valve Replacement

目的：评价主动脉阻断后经主动脉根部注射葛根素注射液对二尖瓣置换术患者心肌损伤的影响。方法：拟行二尖瓣置换术患者60例，性别不限，年龄〈60岁，ASA分级Ⅱ或Ⅲ级，采用随机数字表法，将患者随机分为C组和P组，每组30例。在体外循环下，P组于阻断升主动脉后，立即经升主动脉根部注射葛根素注射液5mg/kg，随后灌注4℃高钾（K＋浓度22 mmol/L）含血心脏停搏液20 mL/kg；C组注射等容量生理盐水，随后灌注4℃高钾（K＋浓度22 mmol/L）含血心脏停搏液20 mL/kg，两组患者每30 min复灌不含葛根素的相同成分含血心脏停搏液10 mL/kg。分别于主动脉阻断前即刻（T1）、主动脉阻断后4 h（T2）和术后24 h（T3）时，采集中心静脉血样8 mL，测定血浆心肌肌钙蛋白I（cTnI）浓度、肌酸激酶（CK）和肌酸激酶同功酶（CK-MB）的活性。记录阻断升主动脉至心脏停搏所用时间、心脏自动复跳率、心脏复跳期间利多卡因使用剂量及术后2h多巴胺用量。结果：与C组比较，P组心脏复跳期间利多卡因用量和术后2 h多巴胺用量减少，两组比较差异均有统计学意义（P〈0.05）。与C组比较，P组T2~T3时血浆cTnI、CK和CK-MB的活性降低，两组比较差异均有统计学意义（P〈0.05）。结论：主动脉阻断后经主动脉根部注射葛根素注射液可减轻二尖瓣置换术患者心肌损伤。

Objective：To investigate the effects of Puerarin injection through aortic root infused on myocardial injury in patients undergoing mitral valve replacement（MVR）. Method：Sixty consenting ASA Ⅱor Ⅲpatients undergoing elective MVR were randomly divided into Puerarin injection group（P）and control group（C）,each group contained 30 cases. In group P myocardial arrest was produced by infusing Puerarin injection 5 mg/kg through aortic root after aorta was cross-clamped followed by cold blood cardioplegic solution 20 mL/kg. In group C asystole was produced with cold blood cardioplegic solution 20 mL/kg alone every 30 min. 8 mL blood samples were taken from the central vein at 5 min before（T1）and 4 h after aortic cross-clamping（T2）24 h after operation（T3）for determination of plasma cardiac troponin I（cTnI）concentration and the creatin kinase（CK）and creatin kinase isoenzyme-MB（CK-MB）. The restoration of spontaneous heart,the amount of dopamine administered during the 2 h after CPB and aortic cross-clamping time were recorded. Result：The lidocaine dosage during cardioversion and the amount of dopamine after surgery 2 h were significantly lower in group P than in group C,and the differences between the two groups were statistically significant（P＆lt;0.05）. The serum cTnI,CK and CK-MB concentration at T2-T3 were significantly lower in group P than in group C,and the difference between the two groups were statistically significant（P＆lt;0.05）. Conclusion：Puerarin injection through aortic root infused can attenuate the myocardial injury in patients undergoing MVR.