磷酸肌酸在心内直视手术中对心肌的保护作用.docVIP

磷酸肌酸在心内直视手术中对心肌的保护作用 　　作者：王立伟1,王建华1,戴体俊　　作者单位：1.徐州市中心医院麻醉科，江苏 徐州 221000;2.徐州医学院麻醉药理教研室，江苏 徐州 　　【摘要】目的：评估磷酸肌酸(creatine phosphate，CP)在心内直视手术中对心肌的保护作用。方法：选取40例先天性心脏病患者,分为实验组和对照组,每组20例。术前两组间性别、年龄、体重、身高、畸形种类、心胸比率及射血分数(EF)无明显区别。实验组于主动脉阻断时经主动脉根部灌注加入磷酸肌酸(10mmol/L)的ST Thomas改良停搏液,对照组停搏液不含磷酸肌酸。分别于麻醉诱导及术后24h抽取静脉血，检测肌酸磷酸激酶同工酶(CK-MB)、心肌肌钙蛋白cTnI的变化，并记录停机时、手术结束后2h和手术结束后24h各时点血流动力学变化及心肌细胞的超微结构变化。结果：实验组于各时点CK-MB及cTnI浓度均显著低于对照组(P0.05),复跳好血流动力学参数及心肌细胞超微结构显变化显著优于对照组(P0.05)。结论：磷酸肌酸能够减轻心肌缺血再灌注损伤,有助于缺血再灌注后心功能的恢复及改善。 　　【关键词】 心脏缺损,先天性,心肌再灌注损伤,心麻痹液,磷酸肌酸,心胸 　　Abstract：Objective： To investigate the effect of exogenous creatine phosphateon myocardial protection in the correction of cardiac defects in children. Methods： Forty cases of children congenital heart disease undergoing correction of cardiac defects were divided randomly into two groups: Group A received modified St.Thomas No 1 solution, and Group B received the same solution but enriched with10mmol/L exogenous creatine phosphate. There were no significant differences between the two groups in age, sex, ratio, diagnosis, C/T ratio and left ventricular function. Blood samples were collected before aortac annulation and at othertime points. An analysis of creatine kinase MB and cardiac-specific troponin I was made in the detection of myocardial damage.The post ischemic ultra-structurein the heart was also observed in two groups. Results： The CK-MB and cTnI levelswere much lower in Group B than those in Group A at 24 h after operation(P0.05).The myocardial cell ultra-structure was better in Group B than that in GroupA. Conclusion： Exogenous creatine phosphate can significantly improvethe myocardial ischemia reperfusion injury and help cardiac function recovery. 　　Key words: heart defects; congenital myocardial reperfusion injury;cardioplegia solution; phosphocreatine 　　临床心血管外科中的心肌保护效果，受到多种因素的影响，如环境、人种、病种、患者术前心功能状态、术前合并症、手术方式、手术技巧及术者熟练程度、麻醉管理以及体外循环技术等。其中，心肌缺血/再灌注损伤最为常见，主要表现为再灌注性心律失常、心肌舒缩功能降低、心肌代谢异常和心肌的超微结构变化等，严重地