1,6-二磷酸果糖冷心停搏液在心脏直视手术中的心肌保护作用

Clinical study on the effect of fructose 1,6-diphosphate cardioplegia for protection of myocardium

目的:研究 1,6 -二磷酸果糖 (FDP)加入冷心停博液对心脏直视手术中的心肌保护作用。方法 :32例先心病患者随机分为对照组和 FDP组 ,停搏液灌注量按 15 m l/ kg灌注 ,间隔 2 0 m in,追加首次量一半。于主动脉插管时和主动脉开放后 10 min、2 h、6 h、12 h及 2 4h从中心静脉采血 ,测定乳酸脱氢酶 (L DH)、磷酸肌酸激酶 (CK)和磷酸肌酸激酶心脏同功酶 (CK- MB)水平 ,并电镜观察两组病人心肌超微结构的改变及心脏自动复跳率。结果 :FDP组术后 3种酶的上升幅度低于对照组 (P <0 .0 1) ,心肌超微结构损害较对照组明显减轻 ,心脏自动复跳率高于对照组 (P <0 .0 5 )。 结论

Objective: To assess the myocardial protective effect of exogenous fructose 1,6 diphosphate sodium (FDP) added into cardioplegia solution during open heart surgery. Methods: 32 patients were randomly divided into control group (St. Thomas Ⅱ cardioplegia) and FDP group (St. Thomas Ⅱ cardioplegia +FDP 10 g/L). Perfusion dose of cardioplegia in control group was 15 ml/kg, then half of the initial dose was repeated every 20 minutes, then the perfusion method of FDP group was the same as the control group. Venous blood samples were collected after aortic cannulation instantly and serial times after aortic declamping respectively. Lactate dephydrogenase (LDH), creative kinase (CK), and creative kinase MB (CK MB) levels were measured and changes of myocardial ultrastructures were observed in both groups. Results: FDP can decrease the increasing levels of LDH, CK and CK MB. After examination it showed better preservation of ultrastructures of myocardial tissue in FDP group than in the control group. The spontaneous recovery rate of heart beat in FDP group was siginificantly higher than in the control group. Conclusion: The data indicate that exogenous fructose 1,6 diphosphate sodium added to the cardioplegia solution offers better significant myocardial protection during open heart surgery with extracorporeal circulation.