摘要
目的:探讨腺苷在婴幼儿先天性心脏病矫治术中的心肌保护作用。方法:将20例法洛四联症(TOF)患儿随机分为腺苷组和对照组,腺苷组在术前静脉滴注腺苷,总量为1.5mg/kg。观察两组心肌电生理指标,正性肌力药用量,分别于转流前、开放循环后30min、术后6、12、24h,取桡动脉血检测肌酸激酶同工酶(CK-MB)、心肌肌钙蛋白I(cTnI)。取右心耳组织观察心肌超微结构。结果:两组主动脉阻断时间无明显差异。术后6h,腺苷组cTnI为(1.04±0.59)μg/L,CK-MB为(26.58±3.21)U/L,升高值明显低于对照组[(3.67±0.62)μg/L;(49.06±11.29)U/L](P<0.01)。腺苷组心肌超微结构保存较好,损伤较对照组小。结论:腺苷可通过模拟预处理效应对婴幼儿未成熟心肌产生保护作用。
Objective: To investigate the myocardioprotective effects of adenosine in infant undergoing open heart surgery. Methods: Twenty infant patients with Tetralogy of Fallot(TOF) underwent operations on cardiopulmonary bypass. They were randomly devided into two groups. adenosine and control. Adenosine was used through intravenous injection in the adenosine group before the cardiopulmonary bypass. The total dosage of adensine was 1. 5mg/kg. Cardiac elec-trophysiologic data and inotropic medicine dosage were measured. Mycocardium enzymes and cardiac troponin I(cTnI) were measured in each group before the cardiopulmonary bypass, 30 min after the aorta off clamping, 6 hours, 12 and 24 hours after operation. The changes of myocardial ultrastructure were studied. Results: There were no significant differences between the two groups in the time of the aorta clamping. At 6 hours after operation, the cTnI (1. 04 ± 0. 59)μg/ L and CK-MB(26. 58 ± 3. 21)U/L of the adenosine group were significantly lower than those of the control group [(3. 67±0. 62)μg/L;(49. 06 ±11. 29)U/L](P<0. 01). The inotropic medicine dosage of the adenosine group was much lower than that in the control group. The myocardial ultrastructure in adenosine group was less damaged than that in the control group. Conclusions: Adenosine can enhance the protection of crystal cardioplegic solutions to the immature myocardim.
