冷血停搏液中加入磷酸肌酸在体外循环手术中的心肌保护效果  

MYOCARDIAL PROTECTION EFFECT OF COLD-BLOODED CARDIOPLEGIA WITH CREATINE PHOSPHATE ON EXTRACORPOREALCIRCULATION

作　　者：傅建学 金新会 祁恒宁 马勇 王锦鹤 

机构地区：[1]青海心脑血管病专科医院麻醉科

出　　处：《青海医学院学报》2010年第4期250-252,270,共4页Journal of Qinghai Medical College

摘　　要：目的认识冷血停搏液中加入磷酸肌酸在体外循环手术中的心肌保护效果。方法 50例病人随机分为实验组(磷酸肌酸组)和对照组,实验组在升主动脉阻断后于主动脉根部顺行灌注含磷酸肌酸(10mmol/L)的冷血停搏液,对照组冷血停搏液不含磷酸肌酸。分别观察两组体外循环、心肌阻断时间,心脏复跳情况及两组正性肌力药物应用剂量,并检测术前、后24 h两个时点两组动脉血肌酸激酶(CK)、肌酸激酶同功酶(CK-MB)、乳酸脱氢酶(LDH)值。结果两组体外循环及心肌阻断时间无差异,心脏自动复跳率无差异;正性肌力药物使用剂量实验组低于对照组,48%的对照组患者需盐酸肾上腺素辅助心功能,高于实验组12%(P<0.01);术后两组心肌酶均升高(P<0.01),实验组较对照组低(P<0.05)。结论含磷酸肌酸的冷血停搏液对心肌细胞损害轻,心律失常发生率降低,心肌细胞功能恢复快,具有较好的心肌保护效果。Objective To investigate the myocardial protection effect of cold - blooded cardioplegia with creatine phosphate on extracorporeal circulation. Methods 50 patients were randomly divided into experimental group （creatine phosphate group ） and the control group. The cold -blooded cardioplegia with creatine phosphate （10mmol/L） were anterograde perfusion after the aorta blocked by aortic root in experimental group. The controls group＇s cold - blooded cardioplegia has not contained creatine phosphate. The extracorporeal circulation, myocardial blocking time and positive inotropic drug doses were observed in both groups. Arterial creatine kinase （CK）, creatine kinase MB isoenzyme （CK - MB） and lactate dehydrogenase （LDH） values were detected in both groups at 24h before and after operation. Results The extraeorporeal circulation, myocardial blocking time and cardiac automatic recovery rate of two groups have no difference. Doses of positive inotropie drug used in experimental group were lower than those in control group. 48 % of patients in the control group need adrenaline hydrochloric acid to support the cardiac function, which was higher than that in experimental group （ 12% , P 〈0.01 ）. Myocardial en-zymes increased in both groups after operation （ P 〈 0.01 ）, but the level of myocardial enzymes in experimental group was lower than that of control group （ P 〈 0.05 ）. Conclusion The cold - blooded cardioplegia with creatine phosphate has little damage on myocardial cell and the rate of occurring arrhythmia is lower. Moreover the cardiocyte function recovery rate is faster and shows good myocardial protection effect.

关 键 词：磷酸肌酸 冷血停搏液 心肌保护 

分 类 号：R614.24[医药卫生—麻醉学]