腺苷在心脏直视术中心肌保护作用的研究.docxVIP

腺苷在心脏直视术中心肌保护作用的研究 中国编辑。 【摘要】 目的 观察外源性腺苷预处理和加入心停搏液两种不同给药方法在心脏直视术中的心肌保护作用。方法7例心脏直视术患者随机分为三组：对照组、腺苷预处理组、腺苷停搏液组，采集桡动脉血测定围手术期血清肌酸激酶同工酶、肌钙蛋白I、丙二醛水平；观察心脏停跳及复跳情况、术后机械通气时间及术后正性肌力药物的应用情况。结果 三组术后CKMB、cTnI、MDA值均较术前显著升高；与组A相比：组B和组C术后多巴胺用量少，组C心脏停搏时间明显缩短，组B开放后h CKMB、h MDA、开放后各时点cTnI显著降低，组C开放后h、h CKMB及开放后各时点MDA、cTnI均显著降低；腺苷处理的两组间比较：组C cTnI在1h显著降低，其余各时间点指标无明显差异。结论 外源性腺苷在心脏直视术中具有心肌保护作用，腺苷加入心停搏液中对心肌的保护作用更具显著性。 【关键词】 腺苷 预处理 心脏直视术 体外循环 心肌保护  Abstract: OBJECTIVE To observe the clinical effects of exogenous adenosine in open heart surgery. METHODS In a randomized prospective study,5patients with open heart surgery were divided in three groups: control group (group A, n=18),adenosine pretreatment group(group B，n=17) and adenosine cardioplegia group(group C，n=22).Blood samples were taken to determine the serum concentrations of CKMB,cTnI and MDA before extracorporeal circulation, h,h and 1h after aortic declamp. Arrest time,spontaneous resuscitation rate,the requirement for inotropics and intubation time were also evaluated. RESULTS The levels of cTnI after aortic declamp and CKMB at h,MDA at h and cTnI after aortic declamp were significantly lower in group B than those in group A. The levels of CKMB at h and h,cTnI and MDA after aortic declamp in group C were significantly lower than those in group level of cTnI at 1h after aortic declamp in group C was significantly lower than that in group B. Arrest time in group C was significantly shorter than that in group A. The requirement for inotropics in group B and group C was significantly lesser than that in group Exogenous adenosine shows effective myocardial protection in open heart surgery, adenosine in cardioplegia solution has a better myocardial protection effect.  Key words： Adenosine;Pretreatment ;Open heart surgery ;Extracorporeal circulation;Myocardial protection  目前临床研究［1］已证实腺苷具有心肌保护作用，但关于腺苷心肌保护作用的临床使用尚无标准化的用药方式［2-3］，本研究根据腺苷预处理及后处理［4］，初步比较心脏直视术前腺苷预适应及术中腺苷加入停搏液中处理在体外循环(extracorporeal circulation,EC