盐酸法舒地尔预防体外循环下二尖瓣置换术心肌缺血再灌注损伤效果分析

Effect of fasudil hydrochloride on prevention of myocardial ischemia reperfusion injury in mitral valve replacement under cardiopulmonary bypass

目的探讨盐酸法舒地尔预防体外循环下二尖瓣置换术心肌缺血再灌注损伤的效果。方法选择2014年1月~2016年12月在我院行择期二尖瓣置换术的患者60例为研究对象,随机分为研究组与对照组各30例。研究组在体外循环心脏停跳液中加入1 mg/kg盐酸法舒地尔注射液,对照组加入等量生理盐水。麻醉诱导成功后切皮前(t1)、体外循环结束时(t2)、体外循环结束后4 h(t3)、体外循环结束后8 h(t4)以及结束后24 h(t5)检测乳酸脱氢酶(LDH)、血浆肌酸激酶同工酶(CK-MB)、血浆肌钙蛋白I(cTnI)。测定心肌细胞凋亡率。结果研究组自动复跳率显著高于对照组,多巴胺显著低于对照组,差异有统计学意义(P<0.05)。对照组在t4及t5时间点LDH显著高于研究组,在t3、t4、t5时间点CK-MB及cTnI水平显著高于研究组,差异均有统计学意义(P<0.05)。研究组心肌细胞凋亡率为(7.7±1.3)%,对照组为(13.1±2.0)%,差异有统计学意义(P<0.05)。结论体外循环下二尖瓣置换术中使用盐酸法舒地尔可显著减轻心肌缺血再灌注损伤。

Objective To investigate the effect of fasudil hydrochloride on prevention of myocardial ischemia-reperfu- sion injury in patients undergoing cardiopulmonary bypass mitral valve replacement. Methods Sixty patients undergoing elective electromyal mitral valve replacement in our hospital from January 2014 to December 2016 were enrolled and randomly divided into study group and control group, with 30 cases in each group. The study group was added with 1 mg/kg fasudil hydrochloride injection into the cardiopulmonary bypass cardioplegia fluid, while the control group was added with the same amount of saline. Lactate dehydrogenase （LDH）, plasma creatine kinase isoenzyme （CK-MB）, plasma troponin I （cTnI） were detected and cardiomyocyte apoptosis rate was determined during anesthesia induction to skin incision（t1）, at the end of cardiopulmonary bypass（t2）, at 4 h, 8 h and 24 h after the end of cardiopulmonary bypass （t3, t4, t5）. Results The auto rebeating rate in the study group was significantly higher than in the control group, and dopamine in the study group was significantly lower than the control group. And the difference was statistically signifi- cant（P〈0.05）. LDH in the control group was significant higher than that in the study group at t4 and t5 time points. The levels of CK-MB and cTnI in the control group were significantly higher than those in the study group at t3, t4 and t5 time pionts. And the differences were statistically significant （P〈0.05）. The apoptotic rate of cardiomyocytes was （7.7± 1.3）% in the study group and （13.1±2.0）% in the control group, and the difference between the two groups was statisti- cally significant （P〈0.05）. Conclusion The use of fasudil hydrochloride in mitral valve replacement under cardiopul- monary bypass can significantly reduce myocardial ischemia-reperfusion injury.