马来酸桂哌齐特在心内直视术中对心肌缺血再灌注损伤的保护作用  

Protective effects of Cinepazide Maleate on myocardial ischemia-reperfusion injury during open heart surgery

作　　者：王尔民[1] 姜建阁[2] 李志魁[1] 

机构地区：[1]德州市人民医院麻醉科,山东德州253014 [2]德州市人民医院检验科,山东德州253014

出　　处：《山东大学学报（医学版）》2008年第2期210-213,共4页Journal of Shandong University:Health Sciences

摘　　要：目的探讨马来酸桂哌齐特在体外循环心内直视手术中对心肌缺血再灌注损伤的保护作用。方法择期成人心内直视手术患者30例,随机分为实验组(n=15)和对照组(n=15)。实验组在首剂500 mL高钾心脏停跳液中加入马来酸桂哌齐特注射液160 mg(4 mL),对照组加入同等剂量(4 mL)的生理盐水。采用大剂量芬太尼辅以异氟醚吸入维持麻醉,浅低温、高流量体外循环。分别检测和观察升主动脉阻断前、开放后0.5、52、4 h的肌酸激酶心型同工酶(CKMB)、心肌肌钙蛋白I(cTnI)的水平及相应时点的平均动脉压(MAP)、心率(HR)等临床指标的变化。结果①术前两组间各项指标及体外循环中的最低温度、体外循环时间、冠脉循环阻断时间等差异均无统计学意义(P>0.05);②实验组心脏自动复跳率(73%)明显高于对照组(33%)(P<0.05);③两组血流动力学变化无统计学意义,但实验组术后24 h内多巴胺需用量明显少于对照组(P<0.05);④术后机械通气及ICU停留时间,实验组明显短于对照组(P<0.05),术后住院日实验组虽短于对照组,但差异无统计学意义(P>0.05);⑤开放后0.5、5、24 h,实验组CKMB均明显低于对照组(P<0.05);在开放后0.5 h时,实验组cTnI低于对照组(P<0.05),开放后5、24 h显著低于对照组(P<0.01)。结论马来酸桂哌齐特在体外循环心内直视术中对心肌缺血再灌注损伤具有保护作用,能明显促进患者心功能的恢复。Objective To investigate the protective effects of Cinepazide Maleate on myocardial ischemia-reperfusion injury during open heart surgery. Methods Thirty adult patients subjected to open heart surgery were randomly divided into the experimental group （group E, n = 15） and the control group （group C, n = 15）. Each group underwent mild hypothermic extraeorporeal circulation, and 160mg （4 mL）Cinepazide Maleate was added into the cold bloody cardioplegia solution in group E and physiolngieal saline （4 mL） was added into group C. The creatine kinase-MB isoenzyme （CKMB） and cardiac Troponin I （cTnI） levels at 0.5, 5 and 24 h after aortic cross-clamp removal were determined and the corresponding changes in hemodynamics were observed. Results ① The self-reheating rate of hearts was significantly higher in group E than in group C （73% vs 33% ） （ P 〈 0.05）. ② Changes in hemodynamics were not significantly different between the two groups, but the dose of dopamine in 24 hours was significantly lower in group E than in group C[ （ 382 ± 28） nag vs （ 404 ± 23） nag] （ P 〈 0.05 ）. ③ Periods of postoperative mechanical ventilation, and hospital ICU stay were significantly shorter in group E （P 〈 0.05）, also the post-operative stay of group E was shorter than that of group C, but there was no obvious difference between the them. ④ After aortic cross-clamp removal, CKMB levels at 0.5, 5, 24 h and cTnI levels at 0.5 h were significantly lower in group E than in group C （ P 〈 0.05）, even mere, cTnI levels at 5 and 24 h were remarkably lower in group E （ P 〈 0.01 ）. Conclusion Cinepazide Maleate could enhance myocardial protective effects on ischemia-repeffusion injury during open heart surgery, and it significantly decreases the CKMB and cTnI levels and improves cardiac functional restoration.

关 键 词：马来酸桂哌齐特 心肌缺血再灌注损伤 体外循环 肌酸激酶心型同工酶 心肌肌钙蛋白I 

分 类 号：R614.25[医药卫生—麻醉学]