心肌肽素在体外循环中对心肌保护的临床研究  

Clinical Study on Myocardial Protective Effect of Cardiomyopeptidin During Cardiopulmonary Bypass

作　　者：周玲善[1] 阮鹏[1] 李刚[1] 李茹冰[2] 孔祥平[2] 

机构地区：[1]解放军第458医院心胸外科,广州510602 [2]解放军第458医院科研室,广州510602

出　　处：《中国体外循环杂志》2005年第3期143-145,共3页Chinese Journal of Extracorporeal Circulation

基　　金：国家863计划(2002AA2Z3119)

摘　　要：目的探讨心肌肽素(CMP)在体外循环中对心肌的保护作用.方法50例风湿性心脏病患者,随机分成对照组和实验组。对照组经升主动脉根部灌注冷晶体停跳液,实验组在晶体停跳液的基础上加入心肌肽素60mg/L。其它处理两组相同。从心肌酶谱(AST、CK-MB、LDH1)、心肌组织细胞形态学、心肌细胞超微结构等观察对心肌的影响。结果(1)两组病例心肌酶在升主动脉开放后显著升高,但实验组明显低于对照组,两组间差异有显著性。(2)心肌组织细胞形态学、细胞超微结构观察发现对照组因缺血、缺氧引起的心肌纤维变性、心肌横纹模糊和空泡样变显著,电镜结果显示对照组术后部分心肌纤维溶解断裂,线粒体肿胀明显;而实验组心肌细胞的形态学超微结构损伤轻。结论心肌肽素加入晶体停跳液中可加强心肌保护,减少心肌酶的释放,心肌细胞超微结构损伤轻,对心肌的保护效果优于单纯晶体停跳液。OBJECTIVE To study the protective effect of the low molecular weight polypeptide cardiomyopeptidin （CMP） extracted from the sucking porcine hearts on the myocardium during the CPB. METHODS 50 patients with rheumatic heart disease were randomly divided into two groups： the control group （n = 25 ） and CMP group （n = 25 ） . In the control group, only crystalloid cardioplegia was given during the CPB , CMP group（60mg/L） was added into the crystalloid cardioplegia. Serial myocardial enzyme examination, cyto - histo - morphological and ultramicrostructural observation were performed. RESULTS There was no difference in enzymes （AST, CK - MB and LDH1） between the two groups before CPB. After opening the aorta, the enzyme activities in CMP group is significantly lower than in control group. The histo - morphological and ultramicrostructural observation showed very serious metamorphic changes in the control group myocardium, but the changes in CMP group is slighter. CONCLUSION Crystalloid cardioplegia with CMP can reduce the release of myocardial enzyme, and have superior protective effect on myocardium than the pure crystalloid cardioplegia.

关 键 词：心肌肽素 体外循环 心肌保护 

分 类 号：R654.1[医药卫生—外科学]