外源性及内源性腺苷预适应在体外循环中的心肌保护作用.docVIP

外源性及内源性腺苷预适应在体外循环中的心肌保护作用 作者:李琳,秦建伟,邵永丰 作者单位：南京医科大学第一附属医院胸心外科，江苏 南京 210029 【摘要】 目的 观察外源性及内源性腺苷预适应在体外循环中对心肌的保护作用。方法 53例心脏瓣膜置换术患者随机分为四组：双嘧达莫组术前口服双嘧达莫（核苷转运抑制剂）；腺苷组转流前微量泵入腺苷；联合组术前口服双嘧达莫，余同腺苷组；对照组泵入等量生理盐水。四组分别于转流前、主动脉开放后2 h、6 h、16 h采集患者桡动脉血，测血清心肌型肌酸磷酸激酶同工酶（CKMB）和心肌肌钙蛋白I（cTnI），并观察术后机械通气时间及术后正性肌力药物的应用等情况。结果 腺苷组术后多巴胺用量少，开放后2 h CKMB、cTnI均较对照组显著降低，联合组开放后各时间点CKMB、cTnI均降低。双嘧达莫组上述变化不明显。结论 外源性腺苷各时间点预适应有显著心肌保护作用，核苷转运抑制剂可增强这一作用。 【关键词】 腺苷；双嘧达莫；体外循环；心肌保护；缺血预适应 　　The Role of Exogenous and Endogenous Adenosine Preconditioning on Myocardial Protection in Extracorporeal Circulation 　　LI Lin,QIN Jian-wei,SHAO Yong-feng,ZHANG Jing,LIANG Yong-nian,LI Zhi 　　(Department of Cardiothoracic Surgery,The First Affiliated Hospital of NJMU,Jiangsu Nanjing 210029,China) 　　Abstract: OBJECTIVE To observe the role of exogenous and endogenous adenosine preconditioning on myocardial protection in extracorporeal circulation（ECC）. METHODS 53 patients who underwent cardiac valve replacement were randomized into four matched groups. Dipyridamole(Dip) group received dipyridamole before operation，Adenosine(Ado) group received adenosine before ECC, Ado+Dip group received both of the two drugs and Control group without dipyridamole and Adenosine. Blood samples were taken to determine the serum concentrations of CKMB and cTnI before ECC, then at 2hours，6hours and 16hours after aortic open-clamp.RESULTS The levels of cTnI after surgery and CKMB at 2hours after aortic open-clamp were significantly lower in the Ado group than in the Cont group, and the levels of CKMB and cTnI after aortic open-clamp in the Ado+Dip group were significantly lower compared with the Cont group,while the levels in the Dip group didnt change great. CONCLUSION Exogenous adenosine preconditoning is effective for myocardial protection,this effect can be enhanced by the nucleoside transporter blocker. 　　Key words： Adenosine;Dipyridamole;Extracorporeal circulation；Myocardial protection；Ischemic precon