心内直视术中肌氨肽苷对心肌保护的临床研究

Effect of muscular amino acids and nucleosides on reducing postischemic myocardium reperfusion injury during open heart surgery

目的 :观测心内直视手术中肌氨肽苷抗心肌缺血 /再灌注损伤的作用 ,评价其心肌保护效果。 方法 :34例体外循环下行瓣膜置换术患者随机分为对照组和治疗组 ,分别于手术前、主动脉阻断前、主动脉开放即刻及主动脉开放后 2、6、12、2 4、4 8、72、96h共 10个时点从中心静脉取血 ,测定心肌肌钙蛋白I(cTnI)、乳酸脱氢酶 (LDH)、磷酸肌酸激酶 (CK)和磷酸肌酸激酶同功酶 (CK MB)水平。 结果 :术前两组的cTnI、LDH、CK、CK MB水平均在正常范围内 ,开放主动脉后 2h开始升高 ,术后 12～ 2 4h达峰值 ,随后缓慢下降。对照组术后各时点cTnI、LDH、CK、CK MB水平明显升高 (P <0 .0 5～ 0 .0 1) ;治疗组cTnI水平较术前无明显升高 (P >0 .0 5 ) ,而LDH、CK、CK MB水平较术前明显升高 (P <0 .0 5 ) ,但升高的程度明显低于对照组 (P <0 .0 5～ 0 .0 1)。 结论 :肌氨肽苷用于冷心停搏液中 。

Objective: To assess the effect of muscular amino acids and nucleosides cold crystalloid cardioplegia on myocardial ischemia reperfusion protection during open heart surgery with extracorporeal circulation. Methods: Thirty four patients with cardiac valvular replacement undergoing open heart surgery were randomly divided into two groups: Control group (n=17) and treated group (n=17), serial venous blood samples were obtained from 2 groups. Before operations, before aortic clamping, aortic off clamping and postoperative 2?6?12?24?48?72?96 h, the levels of cardiac troponin I (cTnI), lactic dehydrogenase (LDH), creatine kinase (CK), creatine kinase MB (CK MB) were measured. Results: cTnI, LDH, CK and CK MB levels measured before operation in two groups were in the normal range;increased significantly 2 h after aorta unclamping and reached a peak at 24 h after operation, and decreased progressively to normal in two groups. In control group cTnI?LDH?CK and CK MB level increased significantly (P<0.01)at different time points after aortic off clamping as compared with that before aortic clamping; In treated group cTnI level and level of LDH?CK and CK MB increased slightly, and there were significant differences about parameters as above between control group and treated group (P<0.05～0.01). Conclusion: Muscular amino acids and nucleosides have notable protective effects on myocardial postischemic reperfusion injury during open heart surgery.