心肌肽素在心脏手术中对心肌的保护作用  

Protective effect of cardiomyopeptidin on myocardial injuries during open heart operation

作　　者：阮鹏[1] 潘志锋[1] 周玲善[1] 邹清雁[2] 孔祥平[2] 李峻[1] 

机构地区：[1]解放军第458医院心胸外科,广州510602 [2]解放军第458医院分子生物学科,广州510602

出　　处：《中华胸心血管外科杂志》2001年第5期288-290,共3页Chinese Journal of Thoracic and Cardiovascular Surgery

基　　金：国家"九五"重点科技攻关项目 ( 96- 90 2 - 0 1 - 0 4 );广东省第十二批重点科技攻关计划( 1 999- 2 4 5 - 1 5 );国家药品监督管理局新药临床研究批件 ( 2 0 0 0XL0 2 89)

摘　　要：目的　探讨从乳猪心肌组织中提取的小分子多肽类物质———心肌肽素 (CMP)在心脏手术中对心肌的保护作用。方法　 5 0例风湿性心脏病人 ,随机均分为对照组和试验组。对照组经升主动脉根部灌注冷晶体高钾停跳液 ,试验组在晶体停跳液的基础上加入心肌肽素 6 0mg/L ,其它处理两组相同。从心肌酶谱 (AST、CK -MB、LDH1)、心肌组织细胞形态学、心肌细胞超微结构等方面观察CMP对心肌的影响。结果　 (1)两组心肌酶谱的变化在CPB转机前无显著差异 ,开放升主动脉后显著升高 ,但试验组明显低于对照组 ,两组间差异有显著性。 (2 )心肌组织形态学和细胞超微结构观察发现 ,对照组因缺血、缺氧引起的心肌纤维变性、心肌横纹模糊和空泡样变显著 ,电镜结果显示对照组术后部分心肌纤维溶解断裂 ,其间可见大量吞饮空泡 ,线粒体肿胀明显 ,部分线粒体嵴消失 ;而试验组心肌细胞的形态学和超微结构改变较轻。结论　心肌肽素加入晶体停跳液中可加强心肌保护 ,减少心肌酶的释放 ,心肌细胞超微结构损伤轻 。Objective: To study the protective effect of the low molecular weight polypeptide cardiomyopeptidin (CMP) extracted from the sucking porcine hearts on the myocardium during the open heart operation. Methods: 50 patients with rheumatic heart disease were randomly divided into two groups, the control group (n=25) and CMP group (n=25). In the control group, only crystalloid cardioplegia was given during the CPB, and in CMP group, CMP (60?mg/L) was added into the crystalloid cardioplegia. Serial myocardial enzyme examination, cyto histo morphological and ultrastructural observation were performed. Results: There was no difference in enzymes (AST, CK MB and LDH 1) between the two groups before CPB. After opening the heart, the enzyme activities in CMP group is significantly lower than in control group. The histo morphological and ultrastructural observation showed very serious metamorphic changes in the control group myocardium, but the changes in CMP group is slighter. Conclusion: Crystalloid cardioplegia with CMP can reduce the release of myocardial enzyme, and have superior protective effect on myocardium than that the pure crystalloid cardioplegia.

关 键 词：心肌 肽类 心脏外科手术 心肌保护 

分 类 号：R654.2[医药卫生—外科学] R977.4[医药卫生—临床医学]