大剂量磷酸肌酸钠预先给药对心脏瓣膜置换术患者心肌缺血再灌注损伤的影响  

Effect of large dose creatine phosphate on myocardial ischemia-reperfusion injury in patients undergoing cardiac valve replacement

作　　者：敖虎山[1] 苏建林[1] 李长营[1] 

机构地区：[1]中国医学科学院北京协和医学院阜外心血管病医院麻醉科,100037

出　　处：《中华麻醉学杂志》2010年第3期344-346,共3页Chinese Journal of Anesthesiology

摘　　要：目的 探讨大剂量磷酸肌酸钠预先给药对心脏瓣膜置换术患者心肌缺血再灌注损伤的影响.方法 择期拟行二尖瓣-主动脉瓣置换术患者246例,年龄42～71岁,体重45～80 kg,随机分为2组：对照组（NS组,n=122）和磷酸肌酸钠预先给药组（CP组,n=124）.CP组切皮时开始中心静脉输注磷酸肌酸钠10g（溶于100ml生理盐水）,输注时间60 min,NS组静脉输注等容量生理盐水,分别于麻醉前、术后第1天和第5天采集颈内静脉血样,检测血清磷酸肌酸激酶、乳酸脱氢酶、肌酸激酶同工酶的活性,测定心肌肌钙蛋白I浓度,观察心律失常、心肌梗塞的发生情况及自动复跳情况,记录使用正性肌力药多巴胺（≥5 μg·kg-1·min-1）和肾上腺素的患者例数及左室射血分数.结果 与NS组比较,CP组术后第1天和第5天血清磷酸肌酸激酶、乳酸脱氢酶、肌酸激酶同工酶的活性及心肌肌钙蛋白I浓度降低,使用多巴胺和肾上腺素的患者例数减少,术后心律失常和心肌梗塞的发生率降低,自动复跳率及左室射血分数升高（P〈0.05）.结论 大剂量磷酸肌酸钠（10 g）预先给药可减轻二尖瓣-主动脉瓣置换术患者的心肌缺血再灌注损伤,改善心脏功能.Objective To investigate the effect of high-dose creatine phosphate （CP） on myocardial ischemia-reperfusion （I/R） injury in patients undergoing cardiac valve replacement. Methods Two hundred and forty-six ASA Ⅱ or Ⅲ patients aged 42-71 yr weighing 45-80 kg undergoing mitral-aortic valve replacement were randomly assigned into 2 groups： control group （ n = 122） and CP group （ n = 124）. CP 10 g in 100 ml normal saline （NS） was infused over 60 min starting from the beginning of operation in group CP. In control group NS 100 ml was infused instead of CP. Blood samples were collected before anesthesia and on 1st and 5th postoperative day for determination of serum CK, CK-MB and LDH activity and cTnI concentration. The number of patients receiving dopamine and adrenaline at the time of return of spontaneous heart beat and 12, 24 and 48 h after operation was recorded. The incidence of arrhythmia （auricular fibrillation, ventricular arrhythmia）, myocardial infarct and left ventricular ejection fraction （LVEF） were also compared between the 2 groups. Results Serum CK, CK-MB and LDH activity and cTnI concentration on 1st and 5th postoperative day, the doses of dopamine and adrenalin, the incidence of arrhythmia and myocardial infarct were significantly lower in group CP than in control group. The postoperative LVEF and the incidence of spontaneous recovery of spontaneous heart-beat were significantly higher in group CP than in control group. Conclusion Pretreatment with high dose CP can protect myocardium against I/R injury in patients undergoing cardiac valve replacement under CPB.

关 键 词：磷酸肌酸 心脏瓣膜 心肌再灌注损伤 

分 类 号：R614[医药卫生—麻醉学]