山茛菪碱防治肺动脉高压患者心肌再灌注损伤的临床研究  

A Clinical Study of Anisodamine on Prevention of Myocardial Reperfusion Injury in Patients with Pulmonary Hypertension

作　　者：王延明[1] 王艳军[1] 臧玉林[1] 张国平[1] 李庆周[1] 宋宇宏 李险波[1] 

机构地区：[1]河北省保定市解放军252医院心胸外科

出　　处：《中国胸心血管外科临床杂志》1999年第2期100-102,共3页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的探讨山茛菪碱（６５４－Ⅱ）对肺动脉高压（ＰＨ）患者心肌再灌注损伤防治机制和心功能保护作用。方法３０例先天性心脏病（ＣＨＤ）合并ＰＨ患者随机分为２组，用药组：在常规心肌保护液中加入６５４－Ⅱ０．５ｍｇ／ｋｇ；对照组：使用常规心肌保护液作为对照。分别测定不同手术时期２组冠状窦血中乙酰胆碱（Ａｃｈ）、Ｃａ２＋、脂质过氧化物（ＬＰＯ）和乳酸（ＬＡ）含量，并经Ｓｗａｎ－Ｇａｎｚ导管测定手术前后心排血量（ＣＯ）及平均肺动脉压（ＭＰＡＰ）的改变。结果再灌注即刻和停机前，对照组冠状窦血中Ａｃｈ，Ｃａ２＋，ＬＰＯ和ＬＡ含量均较用药组明显增加（Ｐ＜０．０５和Ｐ＜０．０１）；转流后用药组ＭＰＡＰ较对照组显著下降（Ｐ＜０．０１）；手术结束时ＣＯ显著增加（Ｐ＜０．０５）。结论在ＣＨＤ合并ＰＨ患者的心肌保护液中加入６５４－Ⅱ可抑制迷走神经活动，增加ＣＯ和早期降低肺动脉压力，从而防治心肌再灌注损伤。Objective To elucidate anisodamine(654 Ⅱ) on the prevention of myocardial reperfusion injury and the protective effect of cardiac function. Methods Thirty congenital heart disease(CHD) patients with pulmonary hypertension were divided into two groups, treatment group (n=15, crystalloid cardioplegic solution+654 Ⅱ 0 5mg/kg) and control group (n=15, crystalloid cardioplegic solution).Cardiopulmonary bypass (CPB) was carried out routinely. Swan Ganz catheter was inserted into pulmonary artery in all patients. Cardiac output (CO) was meassured by thermodilution method and mean pulmonary artery pressure (MPAP) was determined perioperatively. Blood samples was taken from coronary sinus before aortic cross clamping, immediately after release of aortic cross clamping and before stop of CPB for determination of acetylcholine (Ach), Ca 2+ , lipidptroxide (LPO) and lactic acid (LA). Results The content of Ach, Ca 2+ , LPO and LA in treatment group were reduced significantly. A notable increase of CO and reduction of MPAP were also observed in treatment group as compared with the control group. Conclusion These results indicate that 654 Ⅱ may increase CO, decrease the pulmonary arterial pressure and play an important role in the prevention of myocardial reperfusion injury, during open heart operation of CHD patients with pulmonary hypertension.

关 键 词：山莨菪碱 肺动脉高压 再灌注损伤 心肌缺血 

分 类 号：R542.201[医药卫生—心血管疾病] R543.206[医药卫生—内科学]