心瓣膜替换术中冠状动脉灌注参芪扶正注射液的心肌保护作用观察

Observation on Myocardial Protective Effect of Coronary Perfusion of Shenqi Fuzheng Cardioplegic Solution in Patients Undergoing Heart Valve Replacement Operation

目的 :研究风湿性心脏病心瓣膜替换术患者 ,术中应用常温高钾参芪扶正注射液 (作为心麻痹液的组成成分 )进行冠状动脉顺行灌注对心肌的保护作用。方法 :36例风湿性心脏病体外循环下心瓣膜替换术患者 ,随机分为治疗组和对照组 ,每组 18例。治疗组患者术中加用常温高钾参芪扶正注射液进行冠状动脉顺行灌注 ,对照组则应用ST .ThomasⅡ号冷晶体心停搏液 ,两组其他条件相同。结果 :治疗组患者术毕时血管活性药物多巴胺、多巴酚丁胺用量明显少于对照组 (P <0 0 1) ;血清心肌肌钙蛋白I(cTnI)、门冬氨基酸转移酶 (AST)、乳酸脱氢酶 (LDH)、肌酸激酶 (CK)从转流毕到术后 1天明显低于对照组 (P <0 0 5或P <0 0 1) ;治疗组患者术毕心脏自动复跳率明显高于对照组 (P <0 0 1) ;两组患者手术前 1天心脏彩超显示两组患者的心脏指数 (CI)、左心射血分数 (EF)差异无显著性 (P >0 0 5 ) ;术后 7天 ,治疗组CI、EF明显高于对照组 (P <0 0 5 )。心内操作完毕后治疗组心肌超微结构显示心肌细胞水肿轻 ,肌纤维完整 ,而对照组则相反。结论 :心瓣膜替换术应用常温高钾参芪扶正注射液冠状动脉顺行灌注 ,对心肌有良好的保护作用。

Objective: To investigate the myocardial protective effect of coronary perfused ordinary temperature, high potassium Shenqi Fuzheng cardioplegic solution (SFCS) when used as an ingredient of cardiac arresting solution, using in the process of heart valve replacement operation. Methods: Thirty six patients who were undergoing heart valve replacement operation with cardiopulmonary bypass, were randomly divided into two groups, the treated group and the control group, 18 in each group. ST. Thomas Ⅱ cold crystal cardiac arresting liquid was applied in the control group, and SFCS was antegrade applied additionally in the treated group, the other conditions of the two groups were the same. Results: In the treated group, the quantity of vaso active drugs, such as dopamine and dobutamine, used at ending and after operation was significantly less than that in the control group (P<0 01), serum levels of cardial troponin I, aspartate transaminase, lactate dehydrogenase, creatine kinase and creatine kinase MB isozyme, from ending the shunt to 1 day after operation were lower than those in the control group (P<0 05 or P<0 01), the after operational cardiac auto rebeating rate was higher than that in the control group (P<0 01). Using heart color ultrasonogram showed that the cardiac index and left heart ejecting fraction before operation in the two groups were not significantly different but at the 7th day after operation, the two parameters were significantly higher in the treated group than those in the control group (P<0 05). Ultrastructure of myocardium in the treated group after ending the operation showed the cardial cell with only slight edema, and the myocardial fiber was intact, while the condition was the contrary in the control group. Conclusion: Antegrade coronary perfusion of ordinary temperature, high potassium SFCS shows good protective effect on myocardium, and is worth spreading.