大剂量抑肽酶对体外循环心脏瓣膜置换病人心肌保护作用  

Myocardial Protective Effects of Large Dose of Aprotinin on Myocardium during Cardiac Valvular Replacement Operation under Cardiopulmonary Bypass.

作　　者：郭训[1] 刘琴湘[1] 岑欢[1] 邵兵[1] 刘玉妍[1] 黄国栋[1] 胡宁东[1] 周海波[1] 

机构地区：[1]广东省暨南大学医学院第五附属医院广东省清远市人民医院,511500

出　　处：《医学研究杂志》2006年第9期33-35,共3页Journal of Medical Research

摘　　要：目的观察体外循环(CPB)心脏瓣膜置换手术中使用大剂量抑肽酶对心肌的保护作用。方法40例心脏瓣膜置换手术病人,随机分成A组(抑肽组,n=20)和B组(对照组,n=20),A组在体外循环预充液中1次加入5×104kIU/kg抑肽酶;B组在体外循环预充液中加入相等容量的乳酸林格液代替。分别于围术期多时点采取中心静脉血,测定血清心肌肌钙蛋白I(cTnI)、肌酸激酶(CK)及其同工酶(CK-MB)的水平,记录两组转机时间、主动脉阻断时间、开放至复跳时间、自动复跳或电击复跳、复跳后低血压情况。结果A、B两组cTnI在CPB开始后均不同程度升高,A组升高值较B组低,在CPB后各时点的差异显著(P<0·01)。CK、CK-MB明显高于转流前,至开放循环72h后恢复至CPB前水平,A组的变化值均较B组小(P<0·01)。A组心脏自动复跳率、窦性心率恢复率高于B组(P<0·05)。电除颤率、心律失常发生率、复跳后低血压发生率低于B组(P<0·05)。结论体外循环瓣膜置换手术使用大剂量抑肽酶能加强心肌保护的效果,抑肽酶预处理减轻心肌缺血和再灌注造成的损害。Objective To investigate the myocardial protective effects of large dose of aprotinin on myocardium during cardiac valvular replacement operation under cardiopulmonary bypass（CPB）. Methods 40 patients undergoing cardiac valvular replacement operation were randomized into aprotinin group（ group A,n = 20 ） and control group （ group B, n = 20 ）. In group A,5 × 10^4 kIU/kg of aprotinin was added into prime solution of CPB. In group B,the same volume of Ringer＇S solution was given instead of aprotinin. The central venous blood samples were taken at various times during perioperation to measure the serum levels of cTnI, CK and CK - MB. Results After CPB plasma concentration of cTnI was increased in each groups,but the increasing value in group A was lower than that in group B （P 〈 0.01 ）. CK,CK - MB apparently increased,and retuned to the value before CPB at 72h after opening the ascending aorta. The changes of CK,CK - MB in group A were significantly lower than that in group B（P 〈0.0 1 ）. The rate of heart spontaneous re - beating and sinus rhythm recovery werehigher,rate of defibrillation ,Incidence of hypotension after re - beating and arrhythmia were lower in group A than those in group B（P 〈 0.05）. Conclusions Large - dose aprotinin was helpful to myocardial preservation.

关 键 词：抑肽酶 体外循环 心脏瓣膜置换 心肌保护 

分 类 号：R654.2[医药卫生—外科学]