围手术期使用二丁酰环磷腺苷钙对冠状动脉搭桥术患者的心肌保护作用

Effects of perioperative administration of Calcium dibutyryladenosine cyclophosphate on myocardial protection in patients undergoing coronary artery bypass grafting

目的探讨围手术期静脉滴注二丁酰环磷腺苷钙对体外循环下行冠状动脉搭桥术患者心肌缺血再灌注损伤的影响.方法回顾性分析2013年1月至2016年1月西安交通大学第一附属医院心血管外科62例行体外循环下冠状动脉旁路移植术患者的临床资料.围手术期使用二丁酰环磷腺苷钙31例(试验组),围手术期未使用二丁酰环磷腺苷钙31例(对照组).患者均于术前1 h,主动脉开放后2、6、24和72 h采静脉血,检测血清心肌酶[天冬氨酸氨基转移酶(AST)、乳酸脱氢酶(LDH)、肌酸激酶(CK)和肌酸激酶同功酶(CK-MB)]水平.记录两组患者术前和术后心功能指标[每搏输出量(SV)、左室舒张内径(LVDD)、每分输出量(CO)、射血分数(LVEF)].结果两组患者血清AST、LDH、CK和CK-MB水平于主动脉开放后均明显升高.血清AST、LDH和CK水平于主动脉开放后24 h达高峰,且试验组血清CK、AST和LDH水平在主动脉开放后各时间点均较对照组低(P<0.05).两组血清CK-MB水平于主动脉开放后6 h达高峰,且试验组血清CK-MB水平在主动脉开放后6、24和72 h均较对照组低(P<0.05).两组患者术前心功能指标比较差异均无统计学意义(P>0.05),术后试验组SV、CO和LVEF较对照组明显增加而LVDD较对照组明显减小[SV:(70.93±9.72)ml比(65.07±6.81)ml、CO:(5.32±0.98)L比(4.29±0.91)L、LVEF:(57.87±8.92)%比(52.68±7.31)%、LVDD:(55.67±4.12)mm比(62.85±5.71)mm],差异均有统计学意义(P<0.05).结论二丁酰环磷腺苷钙可降低体外循环下冠状动脉搭桥术患者的血清心肌酶水平,对患者心肌缺血再灌注损伤和心功能具有一定的保护作用.

Objective To investigate the effect of Calcium dibutyryladenosine cyclophosphate on myocardial ischemia-reperfusion injury in patients undergoing coronary artery bypass grafting(CABG)operation.Methods The clinical data of 62cases were retrospectively analyzed.These patients were performed coronary artery bypass graft(CABG)operation under cardiopulmonary bypass(CPB)in the First Affiliated Hospital of Medical College of Xi′an Jiaotong University from January 2013 to January 2016.According to the use calcium dibutyryladenosine cyclophosphate,62 patients were divided into the control group and the experimental group.Thirty-one cases in the experimental group were given an intravenous drip of calcium dibutyryladenosine cyclophosphate,while other 31 cases in the control group were not given to calcium dibutyryladenosine cyclophosphate during perioperative period.Venous blood was collected from each patient 1 h before the surgery and 2,6,24 and 72 h after unclamping the aorta,then serum levels of aspartate aminotransferase(AST),lactic acid dehydrogenase(LDH),creatine kinase(CK),and creatine kinase-MB isozyme(CK-MB)were detected.Additionally,cardiac function indices including SV,LVDD,CO,LVEF in these patients were recorded before the operation and 6 days after operation.Results Compared with those before the operation,the levels of serum enzymes were all significantly increased after unclamping the aorta.The levels of serum AST,LDH and CK reached their peak 24 h after unclamping the aorta.Notably,the levels of serum AST,LDH and CK in the experimental group were lower than those in the control group at each time point after unclamping the aorta(P<0.05).For serum CK-MB,the level in both the two groups reached its peak 6 h after unclamping the aorta.The level of CK-MB in the experimental group was significantly decreased compared with that in the control group 6,24 and 72 h after unclamping the aorta(P<0.05).Moreover,there were no signi fi cant differences in cardiac function indices between the 2 groups before the operation(P>0.05).The levels of SV,CO and LVEF in the experimental group were significantly increased while the level of LVDD was obviously decreased compared to that in the control group after the operation,SV:(70.93±9.72)ml vs.(65.07±6.81)ml,CO:(5.32±0.98)L vs.(4.29±0.91)L,LVEF:(57.87±8.92)%vs.(52.68±7.31)%and LVDD:(55.67±4.12)mm vs.(62.85±5.71)mm,and there were statistical differences(P<0.05).Conclusions Calcium dibutyryladenosine cyclophosphate has protective effects on myocardial ischemia-reperfusion injury and cardiac function in patients undergoing CABG operation under CPB,by reducing serum levels of myocardial enzymes in these patients.