左卡尼汀联合参麦注射液应用于不停跳冠状动脉旁路移植手术患者的疗效观察

Clinical effect of levocarnitine combined with Shenmai injection on patients undergoing off-pump coronary artery bypass grafting

目的探讨左卡尼汀联合参麦注射液应用于不停跳冠状动脉旁路移植(CABG)术患者的临床疗效。方法选择2016年1月至2017年12月在北京安贞医院择期行非体外循环CABG术的70例患者,应用随机数字表法分为观察组和对照组,各35例。对照组围术期给予左卡尼汀治疗,观察组围术期在对照组治疗基础上联合参麦注射液治疗,14 d为1个疗程,均治疗2个疗程。观察2组患者治疗前后的心脏指数、心功能指标和血清学指标的变化,比较2组患者在治疗期间发生的不良反应。结果治疗后,观察组和对照组的心脏指数、左心室舒张末期内径、左心室收缩末期内径、左心房舒张末期内径、左心室射血分数均高于治疗前,且观察组高于对照组,观察组和对照组的肌酸激酶同工酶和肌钙蛋白Ⅰ均高于治疗前,但观察组低于对照组[(15.3±3.1)U/L比(19.6±2.8)U/L,(0.03±0.02)μg/L比(0.05±0.02)μg/L](均P<0.05)。2组患者治疗过程中不良反应发生率比较差异无统计学意义(P>0.05)。结论左卡尼汀联合参麦注射液应用于不停跳CABG患者,能改善其心功能和心脏指数,降低血清肌酸激酶同工酶和肌钙蛋白Ⅰ水平,具有心肌保护作用。

ObjectiveTo observe the clinical effect of levocarnitine combined with Shenmai injection on patients undergoing off-pump coronary artery bypass grafting. MethodsSeventy patients undergoing off-pump coronary artery bypass grafting in Beijing Anzhen Hospital, Capital Medical University from January 2016 to December 2017 were randomly divided into observation group（n=35） and control group（n=35）. The control group was treated with levocarnitine and the observation group was treated with levocarnitine plus Shenmai injection during perioperative period; 1 course was 14 d; both groups were treated for 2 courses. Cardiac index, cardiac function indicators and serological indicators were analyzed before and after treatment. Occurrences of adverse reactions were observed during treatment. ResultsAfter treatment, left ventricular end-diastolic diameter, left ventricular end-systolic diameter, left atrial end-diastolic diameter and left ventricular ejection fraction were significantly higher than those before treatment in both groups; cardiac index and cardiac function indicators in observation group were significantly higher than those in control group（P〈0.05）. After treatment, serum levels of creatine kinase isoenzyme and troponin I were significantly higher than those before treatment in both groups; the levels of creatine kinase isoenzyme and troponin I in observation group were significantly lower than those in control group[（15.3±3.1）U/L vs（19.6±2.8）U/L, （0.03±0.02）μg/L vs（0.05±0.02）μg/L]（P〈0.05）. Incidence of adverse reactions showed no significant difference between groups（P〉0.05）. ConclusionLevocarnitine combined with Shenmai injection can improve heart function, reduce serum creatine kinase isoenzyme and troponin I level in patients undergoing off-pump coronary artery bypass grafting.