腺苷预处理对体外循环瓣膜置换病人心肌保护作用临床研究  

Myocardial Protective Effect of Adenosine Preconditioning Against Ischemia-reperfusion Injury in Patients with Valve Replacement Surgery

作　　者：林洁玲[1] 陈海明[1] 许雪梅[1] 张良清[2] 

机构地区：[1]广东湛江中心人民医院麻醉科,524037 [2]广东医学院附属医院麻醉科

出　　处：《医学研究杂志》2006年第6期30-31,67,共3页Journal of Medical Research

基　　金：广东省湛江市科技攻关项目(2003)150号

摘　　要：目的探索腺苷预处理对体外循环瓣膜置换病人的心肌保护作用及临床效果。方法42例择期体外循环瓣膜置换手术患者,随机分为两组。实验组(AP,n=23例)于诱导后转机前以腺苷预处理,腺苷总量以1.5mg/kg,以30～50μg/(kg·min)输入腺苷,30min内用完。对照组按常规处理。分别在术前、阻断前30min、阻断后30min、开放后1h、3h各时间点抽取桡动脉血测定以下指标:cTnI、CK-MB。并记录CPB转机时间、主动脉阻断时间、心脏复跳情况、电除颤、心律失常发生率以及围CPB期间心血管活性药物的使用情况等。结果腺苷预处理组心肌损伤的指标cTnI及CK-MB升高梯度明显低于对照组,心肌保护作用的临床效果明显优于对照组。结论腺苷可模拟预处理对体外循环瓣膜置换病人产生心肌保护作用。Objective To investigate the myocardial protective effect of adenosine preconditioning against ischemia - reperfusion injury in patients who were undergone valve replacement during cardiac pu]monary bypass. Methods 42 patients scheduling for valve replacement operation were divided randomly into two groups： experiment group （ n = 23） and control group （ n = 19） .Adenosine preconditioning were performed in experiment group before cardiac pubnonary bypass. To estimate the plasma level of cardiotroponin I （cTnI）, creatine kinase isoenzyme （CK- MB ）, radialis arterial blood was drown at following time points respectively： before operation, 30 minutes before and after aortic clamp, 1 hour and 3 hours after aortic opened.Meanwhile the rate of heart spontaneous rebeating, defibrillation, arrhythmia and cardiac inotropic agents used and its duration were recorded. Results The elevated range of plasm cTnI and CK- MB in experiment group were obviously lower than that in control group. In experiment group, the rate of heart spontaneous rebeating were higher, but the frequency of defibrillation, arrhythmia and the cardiac inotropic agents used and its duration were lower than those of control group. Conclusion Adenosine preconditioning has notable clinical protective effects on myocardial isehemia- reperfusion injury in patients undergone valve replacement during cardiac pulmonary bypass.

关 键 词：腺苷 缺血预处理 心脏瓣膜疾病 体外循环 心肌 

分 类 号：R654.2[医药卫生—外科学] R971.2[医药卫生—临床医学]