左旋精氨酸对体外循环心内直视手术心肌缺血—再灌注损伤及血浆细胞因子水平的影响  

Effects of L-arginine on myocardial ischemia reperfusion injury and plasma level of cytokines during and after cariopulmonary bypass operation with extracorporeal circulation

作　　者：刘晓川[1] 伯平[2] 谢进生[2] 杨宁[1] 宋士秋[2] 

机构地区：[1]四川省广安市人民医院胸心外科,638000 [2]首都医科大学附属北京安贞医院心外科,北京00029

出　　处：《疑难病杂志》2011年第11期819-821,共3页Chinese Journal of Difficult and Complicated Cases

摘　　要：目的观察左旋精氨酸(L-Arg)对体外循环心内直视手术心肌缺血一再灌注损伤及血浆细胞因子水平的影响。方法 40例在体外循环下行心内直视手术的先天性心脏病患者随机分为对照组(A组)和L-Arg组(B组),A组患者于主动脉开放时经上肢静脉滴入5%葡萄糖注射液50ml;B组患者给予L-Arg,总量为200mg/kg,于主动脉开放时经上肢静脉滴入,30 min内滴完。分别于转流前(T_0)、开放主动脉后30 min(T_1)、CPB后6h(T_2)和24h(T_3)采集患者动脉血测定白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、肌钙蛋白T(cTnT)浓度、丙二醛(MDA)含量及超氧化物歧化酶(SOD)活性。结果 2组内不同时点血浆cTnT、SOD、MDA、IL-6及TNF-α水平两两比较差异有统计学意义(A组MDA水平T_2与T_1比较及B组SOD水平T_3与T_2比较除外,P均<0.05),2组间比较T_0、T_1时点差异无统计学意义(P>0.05),T+2、T_3时点差异有统计学意义(P<0.05)。与对照组比较,L-Arg可显著降低血浆cTnT、TNF-α、IL-6和MDA的上升幅度,提高SOD活性(P<0.05)。结论 L-Arg对体外循环心内直视手术患者有较好的抗炎作用,并对缺血—再灌注损伤心肌有良好的保护作用。Objective To investigate the effects of L-arginine（L-Arg） on myocardial ischemia reperfusion injury and plasma level of cytokines during and after cardiopulmonary bypass（CPB） operation with extracorporeal circulation.Methods 40 patients who suffered from congenital heart diseases were randomly divided into the control group（A group） and L-Arg groups（B group）.L-Arg of 200 mg/kg was infused after aortic off clamping in the B group and 5%glucose of 50 ml was infused in the control group.Before aortic-clamping（T_0） and 30 minutes after aortic off-clamping（T_1）,6 hours（T_3） and 24 hours （T_4）after determination of CPB,blood samples were taken to measure the levels of IL-6,TNF-α,cardiac troponin T（cTnT）, malondialdehyde（MDA）,and the activity of superoxide dismutase（SOD）.Results There were significant differences about the levels of cTnT,MDA,IL-6,TNF-αand SOD in the investigation points（P0.05,except MDA T_1 vs.T_2 in A group; SOD T_3 vs.T_2 in B group） between the two groups.Compared with the A group,the B groups were founded significantly lower the rising tendency of cTnT,TNF-α,IL-6 and MDA,and increased of the activity of SOD in T_2 and T_3（P0.05 ） while there was no significant differences between the 2 groups in T_0 and T_1（P0.05）.Conclusion L-Arg has notable protective effect on ischemia reperfusion myocardium and anti-inflammatory effect during and after open heart surgery with CPB.

关 键 词：左旋精氨酸 体外循环 缺血—再灌注损伤 细胞因子 

分 类 号：R654.1[医药卫生—外科学]