环磷腺苷葡胺在体外循环中对心肌的保护作用要点分析.doc

环磷腺苷葡胺在体外循环中对心肌的保护作用 来源：广东省医药卫生信息网?点击数：254?更新时间：2008-9-8?文章录入：yjhan ???? 【摘要】? 目的 通过观察体外循环(extracorporeal circulation,ECC)中使用环磷腺苷葡胺心肌停博液对围术期心肌酶学、病理学及临床的影响，探讨其在ECC术中的心肌保护作用。方法 选择48例单纯二尖瓣置换手术的患者，随机分为实验组（n=24）和对照组（n=24）。实验组在首次灌注液中加入环磷腺苷葡胺180 mg，对照组沿用4℃的4∶1含血停搏液。分别于ECC前、开放升主动脉后30 min、术后6 h、24 h、48 h共五个时点采集动脉血，检测肌酸激酶同工酶(CKMB)、乳酸脱氢酶(LDH)和心肌肌钙蛋白I(cTnI)。观察围术期临床指标及心肌病理变化。结果 两组患者术后CKMB、LDH和cTnI有显著差异(P0.05)。临床指标及心肌病理变化均支持实验组优于对照组。结论 在心脏停博液中加入环磷腺苷葡胺可在ECC中起到一定的心肌保护作用。 【关键词】? 环磷腺苷葡胺 体外循环 心肌保护 ??? Myocardial Protective Effect of Meglumine Adenosine ??? Cyclophosphate during Extracorporeal Circulation ??? WU Yong1,LIU Gong-jian2 ??? ( 1.Department of Anaesthesiology,The Lianyungang Affiliated Hosipital of Xuzhou Medical College, ??? Jiangsu Lianyungang 222002;2.Department of Anaesthesiology, ??? The Affiliated Hosipital of Xuzhou Medical College,Jiangsu Xuzhou 221002,China) ??? Abstract: OBJECTIVE?? By measurig the changes of myocardial enzyme and pathology to investigate the clinical effect of meglumine adenosine cyclophosphate injection during extracorporeal circulation(ECC)． METHODS? Fourty eight patients scheduled for mitral valve replacement surgery were randomly divided into two groups．Meglumine adenosine cyclophosphate injection (180mg) was added into the prime perfusate during ECC in treated group(n=24) ，but not in control group(n=24)． The changes of myocardial pathology and clinical index were observed.Blood samples were drawn from the artery at the following time points：before ECC，30 min after aortic clamping，6h ，24h and 48h after aortic declamping． Enzyme-linked immunosorbent assays were used to measure the levels of CKMB,LDH and cTnI in plasma．RESULTS? The levels of CKMB,LDH and cTnI in two groups showed significantly difference after ECC(P0.05). The changes of myocardial pathology and clinical index in treated group surpassed that in control group. CONCLUSION? Meglumine adenosine cyclophosphate injection can protect myoeardium after ECC． ??? Key words：? Meglumine a