硫氮卓酮对瓣膜置换术病人心肌的保护作用  

Myocardial protective effect of dilitiazem in patients undergoing cardiac valve replacement

作　　者：黄东越[1] 常业恬[2] 刘流[2] 何小京[2] 吕志平[2] 徐军美 

机构地区：[1]上海市徐汇区中心医院麻醉科,200031 [2]中南大学湘雅二院

出　　处：《临床麻醉学杂志》2007年第3期187-189,共3页Journal of Clinical Anesthesiology

摘　　要：目的观察钙通道阻断药硫氮卓酮对心内直视手术瓣膜置换术中心肌肌钙蛋白I(cTnI)、超氧化物歧化酶(SOD)、丙二醛(MAD)及血清可溶性粘附分子(sICAM-1)的影响,探讨其对心肌的保护作用。方法选择风湿性瓣膜病病人30例,首次在心肺转流(CPB)下行瓣膜置换术。随机均分为三组:Ⅰ组和Ⅱ组为观察组,Ⅲ组为对照组。Ⅰ、Ⅱ组从手术开始至CPB结束分别泵入硫氮卓酮1μg.kg-1.min-1和2μg.kg-1.min-1。分别于切皮前(T1)、主动脉阻断后30min(T2)、主动脉开放后1h(T3)、4h(T4)和24h(T5)抽取桡动脉血,测定Hct、cTnI、SOD、MDA、sICAM-1,并观察病人是否自动复跳、心律失常的情况、复跳后多巴胺的维持量。结果三组cTnI、SOD、MDA、sICAM-1于T2时均较T1时显著升高。Ⅰ组SOD、MDA、sICAM-1于T2时与Ⅲ组比较差异无统计学意义,cTnI明显低于Ⅲ组。Ⅱ组上述各指标T2时均显著低于Ⅲ组和Ⅰ组(P<0.05或P<0.01)。结论心内直视手术中瓣膜置换病人CPB中泵入硫氮卓酮超过2μg.kg-1.min-1方可减少围术期SOD、MDA、sICAM-1的产生和释放,提示对心肌有保护作用。Objective To investigate the effect of dilitiazem on the myocardium in the patients undergoing heart valves surgery under cardiopulmonary bypass （CPB）. Methods Thirty ASA class Ⅰ or Ⅱ patients scheduled for valve replacement were randomly divided into three groups with 10 case each. Diltiazem 1 μg · kg^-1 · min^-1 （group Ⅰ ） or 2 μg · kg^-1 · min^-1 （group Ⅱ ）were pumped respectively from the beginning of operation to the end of CPB. Diltiazm was not given as the contral （group Ⅲ ）. Blood sample was taken from radial artery before operation （T1）, at 30 rnin after aorta clamping（T2）, and 1 h（T3 ）, 4 h（T4 ）, 24 h（T5 ） after aorta declamping for deter ruination of Hct, cTnI,SOD, MDA and sICAM-1. Results cTnI,SOD, MDA,and sICAM-1 increased significantly at T2-5 compared with those at T1 in three groups. There were no significant differences in SOD, MDA, sICAM-1 between group Ⅰ and Ⅱ ,and cTnI was lower in group Ⅰ than that in group Ⅲ during T2-T4, while the variables as above were lower in group Ⅱ than those in group In or Ⅱ. Conclusion Diltiazem pumped at a dose of greater than 2 μg · kg^-1 · min^-1 during CPB can effectively decrease the plasma levels of cTnI,SOD, MDA and sICAM-1 indicating its protective effect on ischemia myocardium in the patients undergoing heart valve replacement under CPB.

关 键 词：硫氮卓酮 心肺转流 心肌保护 瓣膜置换术 

分 类 号：R614[医药卫生—麻醉学]