磷酸肌酸预处理对体外循环未成熟心肌细胞凋亡的影响

Effect of preconditioning with creatine phosphate on immature myocardial apoptosis in extracorporeal circulation

目的探讨外源性磷酸肌酸对体外循环未成熟心肌细胞凋亡的影响。方法 60例法洛四联征或室间隔缺损患儿随机分为观察组与对照组各30例,对照组应用高钾冷晶体心脏停搏液(St.Thomas's停搏液),观察组St.Thomas's停搏液中加入磷酸肌酸。比较2组术前、术后24h心肌酶谱指标、能量物质及心肌细胞凋亡率。结果观察组术后24h肌酸激酶((452.24±123.65)u/L)、肌酸激酶同功酶-MB((21.78±11.10)u/L)、乳酸脱氢酶((458.34±123.45)u/L)、肌钙蛋白T((1.81±1.02)μg/L)及心肌细胞凋亡率((6.58±1.21)%)均明显低于对照组((568.57±135.36)u/L、(38.42±5.36)u/L)、(647.12±162.33)u/L、(2.98±1.12)μg/L及(14.21±1.63)%)(P<0.05);术后三磷酸腺苷、二磷酸腺苷、一磷酸腺苷、磷酸激酶及各物质能量恢复率明显高于对照组(P<0.05)。结论外源性磷酸肌酸可有效维持缺血期间能量供应,提高心肌细胞抗氧化能力,减少心肌细胞凋亡率,对婴幼儿未成熟心肌有保护作用。

Objective To study the effect of creatine phosphate on immature myocardial apoptosis in extracorporeal circulation.Methods Sixty patients with tetralogy of Fallot or ventricular septal defect were divided into observation group and control group,with 30 patients in each group.Control group used high potassium cold crystalloid（St.Thomas’s）,and observation group used creatine phosphate plus St.Thomas’s.The myocardial enzyme spectrum,energy material and myocardial apoptosis were compared before and after operation between two groups.Results The levels of creatine kinase,creatine kinase isoenzyme MB,lactate dehydrogenase,troponin T g/L）and myocardial cell apoptosis rate were obviously lower in 24 hours after operation in observation group（（452.24±123.65）u/L,（21.78±11.10）u/L,（458.34±123.45）u/L）,（1.81±1.02）μg/L,（6.58±1.21）%）than those in control group（（568.57±135.36）u/L,（38.42±5.36）u/L,（647.12±162.33）u/L,（2.98±1.12）μg/L,（14.21±1.63）%）（P〈0.05）.The levels of adenosine triphosphate,adenosine monophosphate,adenosine monophosphate and phosphokinase,and the recovery rates of energy materials were higher after operation in observation group than those in control group（P〈0.05）.Conclusion Creatine phosphate can effectively protect the immature myocardium by maintaining the energy supply during ischemia,improving myocardial cell antioxidant capacity and reducing myocardial apoptosis.