磷酸肌酸钠预先给药对2型糖尿病患者心肌缺血-再灌注损伤的影响

Effect of creatine phosphate on myocardial ischemia-reperfusion in type 2 diabetic patients undergoing cardiac valve replacement

目的探讨磷酸肌酸钠预先给药对2型糖尿病心脏瓣膜置换术患者心肌缺血-再灌注损伤的影响。方法择期行二尖瓣置换术的2型糖尿病患者100例,年龄41～71岁,体重41～78kg,随机均分为两组：糖尿病对照组（NS组）和磷酸肌酸钠预先给药组（CP组）。CP组切皮时开始中心静脉输注磷酸肌酸钠10g（溶于100m性理盐水）,输注时间60min,NS组静脉输注等容量生理盐水,分别于麻醉前、术后第1天和第3天采集颈内静脉血样,检测血清磷酸肌酸激酶（CK）、乳酸脱氢酶（LDH）、肌酸激酶同工酶（CK-MB）,测定心肌肌钙蛋白I浓度（cTnI）,观察自动复跳情况,记录术后3d内使用血管活性药物情况和心血管不良事件发生情况。结果与麻醉前比较,术后第1天两组患者血清CK、LDH、CK-MB、cTnI浓度均明显升高（P〈0.05）;术后第3天NS组CK、LDH、CK-MB、cTnI浓度明显升高（P〈0.05）。与NS组比较,CP组术后第1天和第3天血清CK、LDH、CK-MB、cTnI浓度明显降低（P〈0.05）,术后3d内使用正性肌力药物的例数和术后心血管事件发生例数明显减少（P〈0.05）,术中心脏自动复跳例数明显增多（P〈0.05）。结论磷酸肌酸钠预先给药可减轻2型糖尿病患者心肌缺血-再灌注损伤,改善预后。

Objective This study was to investigate the effect of creatine phosphate（CP）on myocardial ischemeia-reperfusion injury in type 2diabetic patients undergoing cardiac valve replacement.Methods One hundred patients,aged 41-71 year,weighing 41-78 kg,undergoing mitral valve replacement were randomly assigned into 2groups：control group（group NS,n=50）and CP pretreatment group（group CP,n=50）.In group CP,creatine phosphate 10 g in 100 ml normal saline was infused over 60 min starting from the beginning of operation.In group NS,normal saline 100 ml was infused.Blood samples were collected before the anesthesia and at the 1^st and 3^rd postoperative day for determination of serum CK,CK-MB and LDH activity as well as cTnI concentration.The use of vasoactive drugs at the time of return of spontaneous heart beat and after operation was recorded.The incidence of arrhythmia in two groups was compared.Results The serum CK,CK-MB and LDH activity and cTnI concentration in group CP on the 1^st postoperative day and group NS on the 1^st and 3^rd postoperative day were significantly increased when compared with those before anesthesia.When compared with the group NS,the concentration of CK,CK-MB,LDH activity and cTnI on the 1st and3 rd postoperative day were significantly decreased in group CP.The dose of vasoactive drugs,the incidence of arrhythmia were significantly lower and the incidence of spontaneous recovery of heart-beat were significantly higher in group CP than in group NS（P〈0.05）.Conclusion Pretreatment with CP can protect myocardium against I-R injury in patients undergoing cardiac valve replacement under CPB.