磷酸肌酸心脏停搏液心肌保护临床观察

Clinical observations of creatine phosphate cardioplegia on myocardial protection

目的 研究磷酸肌酸对缺血 /再灌注损伤心肌的保护机制。方法 对 16例进行双瓣膜替换术的患者 ,随机分成两组 (各 8例 ) :对照组 (单晶体停搏液组 )和实验组 (晶体停搏液中加入磷酸肌酸 10mmol/L) ;分别于主动脉阻断前 ,开放后 5、15、30、6 0、12 0min抽血测定乳酸 (LA)、丙二醛 (MDA)、超氧化物歧化酶 (SOD)、黄嘌呤氧化酶 (XOD) ;于阻断前 ,开放后 2、2 4和 48h测定心肌肌钙蛋白T(cTnT) ;两组部分患者于心脏阻断后即刻和主动脉开放前 1min ,取左心房心肌做电镜检查。结果 开放后 5、15、30min时实验组LA、MDA含量明显低于对照组 (分别为P <0 .0 5、0 .0 1) ,SOD活性保持明显高于对照组 (P <0 .0 5 ) ,XOD组间无明显差异 ;开放后 2、2 4、48h实验组cTnT显著低于对照组 (P <0 .0 1)。心肌超微结构结果为 :对照组线粒体改变较实验组明显(2 .72 5± 0 .832和 1.872± 0 .5 42 ,P <0 .0 0 1)。结论 磷酸肌酸具有为心肌细胞提供能量、保护细胞膜完整、维持心肌收缩蛋白正常的作用 ,可减轻心肌缺血 /再灌注损伤。

Objective To observe the protective mechanism of creatine phosphate cardioplegia on the myocardium. Method 16 patients were divided into two groups (n=8 respectively):control group (C group) and experimental group (E group). Blood concentrations of the lactic acid (LA), malonyldialdehyde (MDA), superoxide dismuutase (SOD) and xanthine oxidase (XOD) were measured before aortic clamping and 5,15,30,60,120 minutes after release of aortic clamping, cardiac tropomin T (cTnT) wasmeasured before aortic clamping and 2,24,48hours after release of aortic clamping. Just after aortic clamping and before releasing aortic clamping; samples were taken from left atrium and examined under electronmicroscope. Results 5,15,30minutes after releasing aortic clamping the concentrations of LA, MDA in group E were lower than those in group C ( P <0.05, <0.01 respectively); elevation of SOD was higher than that in group C ( P <0.05); there was no difference in XOD between the two groups. 2,24,48 hours after releasing the aortic clamping, the values of cTnT in group E were lower than those in group C ( P <0.01). Electronmicroscopy showed that the mitochondria in group E were better than that in the group C 1.872±0.524 vs 2.725± 0.832 ( P <0.001). Conclusion CP can provide energy for myocardial cells, protect the cell membrane integrity and maintain the normal action of contractile protein. It also shows that CP can relieve the ischemia/reperfusion injury.