自体皮浆移植患者应用大剂量维生素C对心肌损伤的保护  

The clinical study of massive dosage vitamin C in prevention of myocardial injury in burned patients.

作　　者：何为虎 

机构地区：[1]攀枝花钢铁公司总医院,四川攀枝花617023

出　　处：《四川医学》2005年第11期1199-1200,共2页Sichuan Medical Journal

基　　金：2003年四川省科技进步三等奖(2003Y0056)

摘　　要：目的探究自体皮浆移植患者应用大剂量维生素C对心肌损伤的保护作用.方法 64例自体皮浆移植具有心肌损伤的患者随机分成对照组、常规剂量维生素C和大剂量维生素C治疗组3组,于烧伤后4h开始用药,按常规剂量为100～150mg/(kg·d),大剂量为300～400mg/(kg·d),给予快速静脉滴注,1次/d,共10d,且用放射免疫法测定伤后4、12h,第1、2、3、5、7、10、14、18天的血清心肌钙蛋白C(cTnT)和肌酸磷酸激酶的同功酶(CK-MB),同期进行超声心动图和心电检查.结果①与对照组比较,常规维生素C剂量组的各时相除外伤后4、12h和第1天cTnT均降低,但无明显差异(P＞0.05).大剂量组各时相的cTnT均明显降低(P＜0.05),且恢复致正常的时间缩短.②CK-MB的变化与cTnT大致相似.结论早期大剂量快速静脉滴注维生素C对烧伤患者的心肌有较好的保护作用,与常规剂量比较,疗效可靠,无不良反应.Objective To study protective effect of massive dosage vitamin C for myocardial injury in the burned. Methods 64 burned patients with myocardial injury were randomly divided into 3 group,ie. Control（ n = 20） and unsual （ U, n = 22） ,lang （ L, n = 22） groups. Vitamin C quick venous instillation was applied since 4 hours of burn for 10 days, once each day, and the dosage was 100 150mg/（kg· d） in Group U, while 300 - 400mg/（kg· d） in Group L. Radioimmunoassay was adopted to estimate serum cTnT and CK-MB in patients of all groups on 4th, 12th hour and 1 st, 2nd, 3rd, 5th, 7th, 10th, 14th, 18th postburn day, plus ultrasound cardiogram and ECG （electrocardiogram） to monitor cardial function. Results （1） Compared with Group C, the serum cTnT levels lowered at all time phase except 4th,8th hour and first day in Group U （ P 〉 0.05） ,and with no significant difference;while cTnT lowered apparently at all time phase （ P 〈 0.05 ） in Group L, and the time of recovery to nomal was shortened. （2） CK-MB exhibited similar change as that of cTnT. Conclusion Quick venous instillation of massive dosage vitamin C in the early phase of burns has good protective effect in myocardial injury, and is more reliable with no more toxic or side effects compared with routine dosages. Vitamin C, which has extensive resource and which is cheap in price, is worth extending use in such cases.

关 键 词：烧伤 自体皮浆移植 肌钙蛋白 心肌损伤 维生素C 

分 类 号：R622[医药卫生—整形外科]