腺苷在成人心脏外科手术中心肌保护作用临床观察.docVIP

腺苷在成人心脏外科手术中心肌保护作用临床观察 　 作者：刘瑞芳，邢家林，龚庆成，李蔚然，缪娜，柳薇 【摘要】 目的 观察腺苷在成人心脏外科手术中的心肌保护效果。　方法 45例成人心脏手术患者随机分为三组，每组15例，分别为对照组（Ⅰ组）、腺苷停搏液组（Ⅱ组）、腺苷停搏液＋预处理组（Ⅲ组）。测定围术期血浆心肌肌钙蛋白I（cTnI）、肌酸激酶同工酶(CKMB)、乳酸脱氢酶（LDH）、白细胞介素-6（IL-6）、白细胞介素-8（IL-8）水平。术中取心肌组织观察心肌缺血前后超微结构改变。临床观察心脏停跳时间、自动复跳率、术后多巴胺用量、术后拔管时间、ICU滞留时间。　结果 Ⅰ组心脏停搏时间明显长于其他两组。主动脉开放后10 min，cTnI 、IL-8Ⅰ组高于Ⅱ组与Ⅲ组（Plt;0.05），术后1dⅠ组IL-6高于Ⅱ组与Ⅲ组（Plt;0.05）。超微结构观察Ⅰ组心肌损伤程度较Ⅱ组、Ⅲ组重。结论 腺苷可减轻心肌缺血再灌注损伤，具有较好的心肌保护作用。 【关键词】 腺苷；心肌保护；心脏手术；体外循环　 　　The Clinical Study on the Myocardial Protective Effect of Adenosine in Adult Open Heart Surgery 　　　Abstract: OBJECTIVE To investigate the myocardial protective effect of adenosine in adult open heart surgery. METHODS Forty-five patients undergoing elective valve replacement operation were randomly divided to three groups: control group (groupⅠ, n=15), adenosine cardioplegia group (groupⅡ, n=15), adenosine cardioplegia and pretreatment group (group Ⅲ,　n=15). Plasma levels of cardiac troponin I (cTnI), and creatine kinase MB (CKMB),lactate dehydrogenase (LDH), interleukin-6 (IL-6) and interleukin-8 (IL-8) were measured perioperatively. Biopsies of right atrium were taken to be analyzed under electron microscope. Arrest time, spontaneous resuscitation rate, the requirement for inotropics,intubation time and ICU stay time were also evaluated. RESULTS Group Ⅰ had higher cTnI and IL-8 values compared to group Ⅱ and group Ⅲ (Plt;0.05) at 10 min after aotic declamping, and also had higher IL-6 compared to group Ⅱ and group Ⅲ (Plt;0.05) at the point of 1 postoperative day. Ultrastructure changes were slighter in group Ⅱ and group Ⅲ than in group Ⅰ. Arrest time of group Ⅰ was longer than group Ⅱ and group Ⅲ (Plt;0.05). CONCLUSION Adenosine can decrease the ischemia- reperfusion injury,with better myocardial protective effect. 　　Key words： Adenosine;Myocardial protection；Cardiac surgery;Extracorporeal circulation 　　腺苷是一种内源性核苷，三磷酸腺苷（ATP）降解产物，是人体内重要的活性物质之一。近20年来，人们发现腺苷具有强大的心肌保护作用，是缺血预适应过程的触发物质之一，能够减轻心肌缺血再灌注损伤。我们将腺苷用于心脏外科瓣膜手术中，观察其临床