磷酸肌酸钠预处理对非体外循环冠状动脉旁路移植术患者心肌损伤的影响

Effects of creatine phosphate sodium preconditioning on myocardial injury in patients undergoing OPCABG

目的观察磷酸肌酸钠（creatine phosphste sodium）预处理在非体外循环冠状动脉旁路移植术（off-pump coronory or—tery bypass grsfting，OPCABG）中对患者心肌损伤的影响。方法择期拟行OPCABG患者40例，随机分为对照组（C组，20例）和磷酸肌酸钠组（L组，20例）。L组麻醉诱导后开始经中心静脉输注磷酸肌酸钠30mg/kg（溶于100mL生理盐水），输注时间30min，分别于麻醉诱导前（T0）、手术开始时（T1）、主动脉侧壁阻断时（T2）、主动脉侧壁开放时（T3）、关胸后（T4）抽取动脉血，检测血乳酸浓度、血糖浓度。术前1天，术后第1天和第5天检测血清肌酸激酶同工酶（CK—MB）活性，心肌肌钙蛋白I（cTnI）浓度。结果与C组相比，L组血乳酸浓度、血糖浓度在T2-T4时点明显降低（P〈0.05），术后第1天和第5天CK—MB活性及cTnI浓度降低。结论OPCABG患者磷酸肌酸钠预处理可明显降低术中血乳酸浓度，减轻心肌损伤程度。

Objective To observe the effects of creatine phosphate sodium preconditioning on myocardial injuty in patients undergo- ing OPCABG. Methods Forty patients scheduled for OPCABG were randomly assigned into 2 groups：control group（C group,n= 20） and ereatine phosphate sodium group（L group,n =20）. After anesthesia induction,the patients in group L were itrfused ereatine phosphate sodium dissolved into 1001nl of normal saline on the basis of 30mg/kg;the patients in group C were injected equal volume of normal saline. Blood samples were collected before attesthesia （T0）, start of surgery（T1 ）, start of aortic side-bite elalnping（T2 ）, start of aortic side -bite unelalnp- ing（T3 ） and after sterna closure（T4） respectively to measure the level of blood lactate acid and blood glucose. Blood serums were collected on 1st and 5th postoperative day to measure the level of CK - MB and cTni concentration. Results Compared to group C,the concentration of blood lactate acid in group L was significantly lower at T2 -T4 （P 〈 0.05）, while the concentration of blood glucose was markedly lower at T2- T4 （P 〈 0.05） , attd the concentration of CK-MB and eTni in group L was lower at 1st and 5th postoperative day. Conclusion Preconditioning with creatine phosphate sodium cart decrease the concentration of blood lactate acid significantly and protect lnyocardiuln against injuty in pa- tients undergoing OPCABG.