抑肽酶对常温体外循环心脏手术的心肌保护作用

The myocardial preservation of aprotinin on normothermic-CPB heart surgery

目的 :研究抑肽酶在常温体外循环 (CPB)心脏手术中对心肌的影响。方法 :选择先天性心脏病拟行常温CPB心脏手术 6 0例 ,随机均分 3组。Ⅰ组 :不加抑肽酶 ;Ⅱ组 :抑肽酶 5× 10 4 KIU·kg-1加入高钾停跳液内 ;Ⅲ组 :分别以抑肽酶 2 .5× 10 4 KIU·kg-1静注和加入预充液内。观察心肌肌钙蛋白I(cTnI)、超氧化物歧化酶 (SOD)、脂质过氧化物 (LPO)和肌酸激酶 MB (CK MB)及血流动力学的变化。结果 :3组cTnI在CPB开始后均不同程度升高 ,Ⅱ组、Ⅲ组升高值较Ⅰ组低 ,3组在CPB后各时点的差异显著 (P <0 .0 1)。CK MB明显高于转流前 ,至开放循环 72h后恢复至CPB前水平 ;SOD在开放升主动脉后持续性下降 ,开放 12h后逐渐恢复 ;LPO在开放升主动脉后均明显升高 ,于 12h后则明显下降且呈递减趋势 ;在上述生化检查中Ⅱ组、Ⅲ组的变化值均较Ⅰ组小 ,3组差异有统计学意义 (P <0 .0 1) ,Ⅱ组与Ⅲ组比较差别不大 (P >0 .0 5 )。Ⅲ组心脏自动复跳率、窦性心率恢复率高于Ⅱ组和Ⅰ组 (P <0 .0 5 ) ,电除颤率、心律失常发生率低于Ⅱ组和Ⅰ组 (P <0 .0 5 )。各时段Ⅲ组和Ⅱ组所需正性肌力药物剂量、种类和维持时间均少于Ⅰ组 (P <0 .0 5 )。 3组复跳后及其后各时点心排血量 (CO)、心脏指数 (CI)、左室搏功指数 (LVSWI)

Objective:To evaluate the myocardial protective effect of aprotinin on normothermic cardiopulmonary bypass(CPB )heart surgery.Methods:Sixty patients with congenital heart disease undergoing normothermic CPB were randomly divided into group Ⅰ(unused aprotinin), groupⅡand group Ⅲ.GroupⅡpatients received aprotinin 5×104KIU·kg -1 in hyper k+ cardioplegia.Group Ⅲ patients received 2.5×104KIU·kg -1 and also added to CPB priming solution.Serum samples were collected for measurement of cardiac troponinI(cTnI),creatine kinase MB(CK-MB),superoxide dismutase(SOD) and lipid peroxidation(LPO) at various times during operation.The changes of hemodynamics indices were recorded. Results :After CPB plasma concentration of cTnI increased in all groups,but the increase values in group Ⅱ and group Ⅲ were lower than that in group Ⅰ( P <0.01). CK-MB apparently increased,and returned to the value before CPB at 72h after opening the ascending aorta.SOD descedned continuously until 12h after opening the ascending aorta,then ascended gradually. LPO significantly increased after opening the ascending aorta, apparently descended at 12h after opening the ascending aorta.The changes of CK-MB,SOD and LPO in groupⅡandⅢwere significantly lower than those in groupⅠ( P <0.01),but there was no differnce between groupⅡandⅢ.In groupⅡand groupⅢ, the rate of heart spontaneous re-beating and sinus rhythm recovery were higher,rate of defibrillation and arrhythmia as well as the kind and dose of cardiac inotropic agents used and its duration were lower than those of group Ⅰ.In three groups,cardiac output(CO),cardiac index(CI),stroke volume(SV)were increased,mean pulmonary arterial pressure(PAP),pulmonary capillary wedge pressure(PCWP),pulmonary vascular resistance(PVR),systemic vascular resistance(SVR) were decreased,but the degree of change in groupⅡand group Ⅲ was more than that in group Ⅰ( P <0.05).Heart rate (HR) and mean arterial pressure (MAP)were not changed after induction and CPB 5min( P >0.05). Conclusion :Aprotinin possesses the myocardial preservation on normothermic CPB vision cardiac surgery