左旋精氨酸心脏停搏液对心肌的保护作用  

Protection of L-arginine cardioplegia on myocardium during cardiopulmonary bypass

作　　者：姜桢[1] 夏利民[2] 叶磊[2] 

机构地区：[1]上海医科大学中山医院麻醉科 [2]上海医科大学中山医院心外科200032

出　　处：《中华麻醉学杂志》1998年第12期710-713,共4页Chinese Journal of Anesthesiology

摘　　要：目的:研究左旋精氨酸对缺血/再灌注损伤心肌的保护机制。方法:14例进行双瓣膜替换术的患者,随机分成两组:对照组(单晶体停搏液)和试验组(晶体停搏液中加入左旋精氨酸);于主动脉阻断前、开放后测定血浆亚硝酸盐/硝酸盐,乳酸,丙二醛,超氧化物歧化酶和黄嘌呤氧化酶;各组患者于心脏阻断后即刻、主动脉开放前1分,取左心房心肌做电镜检查。结果:对照组主动脉开放后。亚硝酸盐/硝酸盐浓度即下降,30分起与阻断前有明显差异(P<0.05),试验组开放后即明显上升(P<0.05),60分时达顶峰;主动脉开放后5、15、30分时试验组血浆乳酸及丙二醛含量明显低于对照组(P<0.01或P<0.05),开放后30、60分超氧化物歧化酶活性明显高于对照组(P<0.01),黄嘌呤氧化酶组间无明显差异。心肌超微结构为:对照组线粒体改变明显重于试验组。结论:左旋精氨酸具有减轻心肌缺血/再灌注损伤的作用。Objective:To study if L-arginine cardioplegia can protect myocardium from ischemia/reperfusion injury. Method:Fourteen patients undergoing valve replacement were randomly divided into two groups:control group (crystal cardioplegia,C group),and test group(crystal cardioplegia+L-arginine,E group). Before aortic-clamping and after aortic unclamping,blood samples were taken to measure the concentrations of NO_2^-/NO_3^-, lactic acid (LA), malonylaldehyde (MDA), superoxide dismutase (SOD), xanthine oxidase (XOD). Immediately after aortic clamping and before aortic-unclamping, tissues were taken from the left atrial and examed with electron microscopy. Result: In C group NO_2^-/NO_3^- level decreased at aortic unclamping, 30 minutes later decreased significantly compared with that before aortic-clamping(P<0.05); In E group it increased at aortic unclamping(P<0.05). 60 minutes later increased to peak. 5,15 and 30 minutes after aortic-unclamping,the concentrations of LA and MDA in E group were lower than those in C group(P<0.01 or P<0.05). 30 and 60 minutes after aortic-unclamping,the concentrations of SOD were maintained higher in E group than those in C group(P<0.01). There was no difference between both groups in the concentration of XOD. The findings of electronmicroscopy indicated that the mitochondrial in E group was maintained better than that in C group. Conclusion: L-arginine can protect effectively myocardium from ischemia/reperfusion injury.

关 键 词：左旋精氨酸 再灌注损伤 心脏停搏液 心肌缺血 

分 类 号：R654.205[医药卫生—外科学]