丹参多酚酸盐对体外循环心瓣膜置换术心肌保护的作用  

Myocardial protection effect of salvianolate in heart value replacement with extracorporeal circulation

作　　者：缪丙荣[1] 

机构地区：[1]江苏省徐州市中心医院心脏外科,221009

出　　处：《中国医药》2012年第12期1500-1502,共3页China Medicine

摘　　要：目的观察丹参多酚酸盐在体外循环心瓣膜置换术中对心肌是否具有保护作用及其在手术中的安全性。方法将需要进行心瓣膜置换术的42例患者完全随机分为试验组和对照组各21例。试验组术前丹参多酚酸盐200mg静脉给药。对照组：5％葡萄糖液250ml术前静脉滴注。2组均行胸骨正中切口，全身进行肝素化，建立体外循环通道，上下腔静脉插管，降低心脏表面的温度并阻断主动脉后，灌注心脏停搏液，主动脉阻断问隔时间超过30min后再次灌注心脏停搏液，术中均采用间断缝合置换瓣膜。记录主动脉阻断前、阻断后4、12、24h患者的血气分析结果和血流动力学指标、心脏恢复搏动情况、多巴胺用量、术后辅助呼吸的时间、在ICU中恢复的时间、24h胸腔引流量，记录麻醉诱导完成时、开放主动脉时、停止辅助循环时、手术结束和术后1d采血检测肌酸激酶同工酶（CK—MB）、血清心肌肌钙蛋白I（eTnI）、丙二醛的含量和超氧化物歧化酶（SOD）活力。结果主动脉阻断后12h这个时间点，试验组和对照组的血氧分压分别为（97±4）mmHg（1mmHg=0．133kPa）、（924-4）mmHg，试验组明显高于对照组（P〈0．05），试验组和对照组的血乳酸含量分别为（5．324-1．46）mmol／L、（8．334-1．85）mmol／L，试验组明显低于对照组（P〈0．05）。试验组术后辅助呼吸时间和ICU内恢复时间为（9．34-2．3）h、（404-7）h，短于对照组（14．24-6．7）h、（504-11）h，2组ICU内恢复时间和术后辅助呼吸时间比较差异均有统计学意义（均P〈0．05）。从麻醉诱导到术后1d的各时间点，试验组的CK—MB、eTnI、丙二醛含量、SOD活性与对照组相比均有不同程度的降低或提高，开放主动脉及术后1d时，CK—MB及eTnI降低比较明显（P〈0．05）；在停止辅助循环及手术截止时丙二醛含量明显降低，SOD活性明显提高（PObjective To observe the protective effect of salvianolate on myocardium in valve replacement with cardiopulmonary bypass. Methods Patients who needed cardiac valve replacement were randomly divided into two groups. Two groups had median sternotomy incision; systemic heparinization were used in the whole body to establish off-channel; tube were inserted inferior vena cava to reduce the temperature of the surface on the heart and aortic occlusion. Interrupted sutures were used to replace valve during surgery. Patients in the trial group were given salvianoiate of 200 mg intravenously. The blood gas analysis results, hemodynamic parameters before aorta clamping and 4h, 12 h and 24 h after aorta clamping were recorded. The recovery of heartbeat, dosage of dopamine, the time of postoperative respiratory support and recovery in ICU, the amount of drainage in 24 hours were recorded. The levels of creatine kinase MB （ CK-MB ） isoenzyme, serum cardial troponin I （ cTn I ）, malondialdehude （MDA） and activity of superoxide dismutase （SOD） after induction of anesthesia, aorta opening, termination of cardiopulmonary bypass, at the end of operation and one day after operation were also recorded. Results Twelve hours after main artery occlusion, blood oxygen partial pressure of the experimental group and of the control group was respectively（97 ~ 4） mm Hg and （92 -＋ 3 ） mm Hg; the experimental group was significantly higher than the control group （ P 〈 0.05 ）. Lactic acid levels in the pilot group and blood the control group were respectively （ 5.32 ＋ 1.46） mmol/L and （ 8.33 ＋ 1.58 ） mmol/L （ P 〈 0.05 ）. In pilot group the ICU recovery time and assisted respiration time were all statistically shorter than those in the control group （ P 〈 0.05 ）. The levels of CK-MB, cTn I , MDA and SOD in trial group decreased or increased in different degree compared with control group. At each time point from aortic unclamping to the first day postoperative, the levels of CK-MB and cTn

关 键 词：心瓣膜置换术 丹参多酚酸盐 体外循环 心肌保护 氧自由基 

分 类 号：R654.2[医药卫生—外科学]