两种途径给予磷酸肌酸对心脏瓣膜置换术患者的心肌保护作用对比观察

发布时间：2018-10-08 07:15

【摘要】：目的比较两种途径给予磷酸肌酸(CP)对心脏瓣膜置换术患者的心肌保护作用。方法将45例进行二尖瓣置换术患者随机分为A、B、C组各15例。A组术前2 d及手术当日外周静脉分别滴入100 m L生理盐水。B组将CP(33 mg/kg)加入生理盐水100 m L中,用法同A组。C组将CP加入心肌停搏液中,配成10 mmol/L的CP(每2.5 g CP加入1 000 m L停搏液中),其余同A组。观察各组麻醉诱导前5 min(T0)及主动脉钳开放后30 min(T1)、6 h(T2)、24 h(T3)血浆肌酸激酶同工酶(CK-MB)、心肌肌钙蛋白I(c Tn I)水平,记录术中主动脉阻断时间、体外循环时间、术后24 h多巴胺用量、心脏自动复跳率、重复除颤例数、肾上腺素使用例数、术后24 h内室性心律失常发生率。结果与T0时点比较,三组T1、T2、T3时点CK-MB、c Tn I水平升高(P均0.05)。与A组比较,B组T2时点CK-MB水平和T1、T2时点c Tn I水平降低,C组T1、T2时点CK-MB水平和T1、T2、T3时点c Tn I水平降低(P均0.05)。与B组比较,C组T1、T2时点c Tn I水平降低(P均0.05)。与A组比较,B、C组重复除颤数、术后24 h多巴胺用量少(P均0.05),C组心脏自动复跳率高(P0.05)。结论术前应用CP对体外循环下心脏瓣膜置换术中心肌有保护作用,将CP加入心脏停搏液中的效果好于静滴。
[Abstract]:Objective to compare the myocardial protective effects of creatine phosphate (CP) on cardiac valve replacement patients. Methods 45 patients undergoing mitral valve replacement were randomly divided into group A (n = 15), group A (n = 15) and group A (n = 15). The peripheral vein was dripped into 100ml of normal saline on the 2nd day before operation and on the day of operation. Group B added CP (33 mg/kg) into 100ml of normal saline. Methods CP was added to myocardial cardioplegia for 10 mmol/L in group A (2.5 g / L CP), and the rest was the same as group A. The levels of creatine kinase isoenzyme (CK-MB), cardiac troponin I (c Tn I) (I (c Tn I), aortic occlusion time (CPB) and dopamine (DA) were measured at 5 min (T0) before anesthesia induction and 30 min (T1) 6 h (T2) 24 h (T3) after aortic forceps opening in each group. The incidence of ventricular arrhythmia within 24 hours after operation was determined by the rate of automatic cardiac repulse, the number of repeated defibrillation cases, and the use of adrenaline. Results compared with T 0, the level of CK-MB,c Tn I at T 1 T 2 T 3 in the three groups was higher than that at T 0 time (all P 0. 05). Compared with group A, the levels of CK-MB at T 2 and c Tn I at T 1 T 2 in group B were significantly lower than those in group C at T 1 T 2 and c Tn I at T 2 T 3 (all P 0. 05). The level of c Tn I at T 1 T 2 in C group was lower than that in B group (P 0. 05). Compared with group A, the number of repetitive defibrillation and the dosage of dopamine at 24 hours after operation in group C were lower than those in group A (P 0.05), and the rate of automatic cardiac rebeat in group C was higher than that in group C (P0.05). Conclusion preoperative application of CP has protective effect on the central muscle of cardiac valve replacement under cardiopulmonary bypass. The effect of adding CP into cardioplegia is better than that of intravenous drip.
【作者单位】：南京医科大学附属无锡市人民医院;
【分类号】：R654.2

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