左旋精氨酸和1，6-二磷酸果糖联合应用抗心肌缺血/再灌注损伤的临床研究  

Clinical study on the effect of L-arginine and fructose-1,6-diphosphate on myocardial ischemia reperfusion injury

作　　者：冷玉芳[1] 陈远丰[1] 马玉清[1] 

机构地区：[1]兰州大学第一医院麻醉科,730000

出　　处：《中国急救医学》2007年第1期8-11,共4页Chinese Journal of Critical Care Medicine

基　　金：甘肃省自然科学基金项目(No.ZS981-A23-077-Y)

摘　　要：目的探讨左旋精氨酸(L-Arg)和1,6-二磷酸果糖(FDP)联合应用对体外循环心内直视手术中心肌缺血/再灌注损伤的保护作用。方法拟行心内直视手术的先天性心脏病室间隔缺损或房间隔缺损患者40例,随机分为对照组(A组)、L-Arg组(B组)、FDP组(C组)和联合用药组(D组),每组各10例。根据L-Arg和FDP作用机制的不同,B组于主动脉开放后给予L -Arg 200 mg/kg；C组于主动脉阻断前给予FDP 200 mg/kg；D组联合应用这两种药物。分别于主动脉插管时及主动脉开放后30 min、2 h、6h检测血浆心肌肌钙蛋白T(cTnT)、乳酸脱氢酶(LDH)、肌酸激酶同工酶(CK-MB)、丙二醛(MDA)含量、及超氧化物歧化酶(SOD)活性。结果治疗各组与对照组比较,可显著降低血浆cTnT、LDH、CK-MB和MDA的上升幅度,提高SOD活性(P＜0．05或P＜0．01),且D组与B组、C组比较可显著降低血浆cTnT的上升幅度(P＜0．05)。结论L- Arg和FDP对心内直视手术中缺血/再灌注损伤心肌有良好的保护作用,联合应用优于两药单用。Objective To investigate the protective effects of L- arginine（ L -Arg）and fructose - 1,6 - diphosphate（ FDP） on myocardial ischemia reperfusion injury during open heart surgery with cardiopulmonary bypass （ CPB）. Methods 40 patients suffering from congenital ventricular septal defect or atrial septal defect were randomly divided into the control group and the treatment groups （ L - Arg, FDP, L -Arg plus FDP）, 10 in each group. L- Arg（200 mg/kg） was infused after aortic off-clamping in B group. FDP（200 mg/kg） was infused before aortic- clamping in C group. Both L- Arg and FDP were infused in D group. Before aortic - clamping and 30 minutes, 2 hours, 6 hours after aortic off - clamping, blood samples were taken to measure the levels of cardiac troponin T （ cTnT）, lactate dehydrogenase （ LDH）, MB isoenzyme of creatine kinase （CK - MB）, malondialdehyde （MDA ） and the activity of superoxide dismutase （ SOD）. Results Compared with the control group, the treatment groups could significandy lower the rising tendency of cTnT, LDH ,CK - MB and MDA, and increase the activity of SOD. Compared with L - Arg group and FDP group, L - Arg and FDP group could significantly lower the rising tendency of cTnT. Conclusion L - Arg and FDP has notable protective effect on ischemia reperfusion myocardium during open heart surgery with CPB, which is better than using the 2 medicines separately.

关 键 词：左旋精氨酸 1 6-二磷酸果糖 体外循环 心肌缺血/再灌注损伤 

分 类 号：R541[医药卫生—心血管疾病]