前列地尔对体外循环心瓣膜替换术患者术中的心肌保护作用  

Myocardial Preservation of Prostaglandin E1 in Cardioplegia Solution on Patients Undergoing Heart Valve Replacement Operation

作　　者：高国栋[1] 龙村[1] 谢颖 袁媛[1] 

机构地区：[1]中国医学科学院阜外心血管病医院体外循环科,100037 [2]四川省南充市中心医院麻醉科

出　　处：《中华临床医学杂志》2008年第6期5-7,共3页Chinese Journal of Clinical Practical Medicine

摘　　要：目的研究风湿性心脏病心瓣膜置换术患者，术中应用前列地尔（PGE1）作为心肌保护液的组成成分进行冠状动脉顺行性灌注对心肌的保护作用。方法50例风湿性心脏病心瓣膜置换术患者，随机分为治疗组和对照组两组，每组各25例。治疗组术中于St．ThomasⅡ号冷晶体心肌保护液中一次性加入PGE1 0μg，对照组则单纯应用St、ThomasⅡ号冷晶体心肌保护液，两组其他条件相同。分别于术前，体外循环30min，升主动脉开放后5min，1，2、6、24h取血标本测量超氧化物歧化酶（SOD）活性、血清乳酸脱氢酶（LDH）、磷酸肌酸激酶（CK）、磷酸肌酸激酶同工酶（CK-MB）、肌钙蛋白Ⅰ（cTnⅠ）水平，记录升主动脉开放后心脏复跳及术后正性肌力药物的应用情况。结果cTnⅠ、LDH复灌后1h到24h；CK复灌后5min到24h；CK-MB复灌后6、24h，治疗组明显低于对照组。血清SOD活性治疗组复灌后1、2、6h明显高于对照组（P〈0.05）。心脏自动复跳率治疗组为80％，对照组为68％，两组比较无统计学意义。多巴胺用量治疗组明显低于对照组（P〈0.05）。结论在心脏瓣膜置换术中，应用前列地尔作为心脏停跳液的组成成分进行冠状动脉顺行性灌注，可对心肌有较好的保护作用。Objective To investigate the myocardial preservation ofprostaglandin E1 as an ingredient of cardiac arresting solution in the process of heart valve replacement operation. Methods 50 cases undergoing heart valve replace with cardiopulmonary bypass（CPB）,23 males and 27 females, aged 23-67 years（mean 45.3 ± 14.2 years）,were divided into 2 groups： test group（n=25,10μg prostaglandin E1 was put in the St.Thomas Ⅱ cold crystal cardiac arresting liquid） and control group （n=25, no prostaglandin E1 was put in the St.Thomas Ⅱ cold crystal cardiac arresting liquid）.before operation, 30 minutes after the beginning of CPB, 5 minutes, 1 hour, 2 hours, 6 hours and 24 hours after reperfusion venous blood was drawn to test the serum cardiac troponin Ⅰ（cTnⅠ）, lactate dehydrogenase （LDH）, creatine kinase （CK）, MB isoenzyme of creatine kinase （CK-MB） and superoxide dimutase （SOD）. The amounts of vaso-active drugs, such as dopamine, used postoperatively, and the postoperative cardiac auto rebeating rate were recorded. Results The amounts of vaso-active drugs used in the test group was significantly less than in the control group（P〈0.05）. The serum levels of LDH and cTnⅠ were significantly lower in the test group than in the control group since reperfusion 1 hour to 24 hours. CK were significantly lower in the test group since reperfusion 5 mintues to 24 hours.CK-MB were ere significantly lower in the test group since reperfusion 6 hours to 24 hours. SOD were were significantly lower in the test group since reperfusion 1 hour to 6 hours. The postoperative cardiac auto rebeating rate 80% in test group and 68% in control group, but there was no significant between these two groups. Conclusion Antegrade coronary perfusion of prostaglandin El has a good protective effect on myocardium and worth spreading for heart valve replacement with cardiopulmonary bypass.

关 键 词：前列地尔 心肌保护 体外循环 

分 类 号：R654.2[医药卫生—外科学]