体外循环应用磷酸肌酸对心肌保护作用效果影响的临床研究  

The Role of Creatine Kinase in the Effectiveness of Myocardial Protection

作　　者：李也牧[1] 王健[1] 戴晋[1] 郭涛[1] 曹熙汉[1] 张斌[1] 张亚健[1] 

机构地区：[1]锦州市中心医院麻醉科,辽宁锦州121001

出　　处：《中国医药指南》2013年第17期417-418,共2页Guide of China Medicine

摘　　要：目的本研究在体外循环心肌保护液中应用磷酸肌酸(CP),观察心内直视手术患者的心肌酶谱的变化,分析其心肌保护作用的效果。方法将100例心脏手术患者分成实验组与对照组,分别观察体外循环前、体外循环后的心肌酶谱(CK、CKMB)的变化趋势,以及患者自动恢复窦性心律或发生心律失常或应用正性肌力药情况。实验组患者在阻断主动脉后,从主动脉根部或冠状动脉灌注含有CP的心肌保护液,对照组应用常规心肌保护液(STH)。结果实验组体外循环前、体外循环后心肌酶谱(CK、CKMB)的变化不显著(P>0.05),而对照组的体外循环前、体外循环后心肌酶谱变化明显(P<0.05)。实验组体外循环结束后自主恢复窦性心律及心律失常发生率和应用正性肌力药维持心功能及血流动力学均好于对照组。结论磷酸肌酸作为心肌的代谢基质确实具有增强心脏停搏液的保护作用,术后血流动力学和心脏电生理指标恢复满意,复苏需用电除颤的比例降低,患者自主恢复窦性心率的比例升高。Objective The purpose of this project is the observation of change of myocardial enzymes of surgical patients under direct vision of cardiology, creatine kinase is added, in order to judge the effectiveness of its myocardial cytoprotective effects. Methods 100 cases patients whQ need surgery were divi.ded into experimental and control groups to respectively observe the changes of myocardial enzymes, spontaneous restoration of sinus rhythm, arrhythmia, positive inotropic drugs situation before and after cardiopulmonary bypass. The patients of experimental group were perfused by protective liquid of Myocardial cells containing CP （lOmmol/L CP was joined in STH）. Conventional cardioplegia was used in the control group. Result The changes of cardiac enzymes is not significant （/〉0.05） in the experimental group before and after cardiopulmonary bypass. The changes of cardiac enzymes is significant （P〈0.05） in the control group before and after cardiopulmonary bypass. The role in the effectiveness of spontaneous return to sinus rhythm, arrhythmia, and application myocardial inotropic drugs of the experimental group were better than them of the control group. Conclusion Creatine kinase significantly enhanced the protective effect of cardioplegic solution. It contributes to recovery of indicators of electrophysiological and hemodynamic. At the same time it can reduce the proportion of defibrillation, however significantly, it can raise the proportion of spontaneous restoration of sinus rhythm.

关 键 词：心脏直视手术 体外循环 磷酸肌酸 心肌保护 

分 类 号：R654[医药卫生—外科学]