二尖瓣置换术患者体外循环中应用法舒地尔的临床疗效观察  

Clinical observation for the therapeutic effects of fasudil hydrochloride during cardiopulmonary bypass in patients receiving mitral valve replacement

作　　者：李倩[1] 尚艳慧 刘苏[1] 刘林力[1] 陈立华[1] 尹晨[1] 

机构地区：[1]河北医科大学第二医院心脏外科,石家庄市050000

出　　处：《河北医药》2016年第15期2254-2258,共5页Hebei Medical Journal

摘　　要：目的观察体外循环下二尖瓣置换术患者应用法舒地尔后心肌保护和临床治疗作用。方法二尖瓣置换术患者40例,随机分为试验组（法舒地尔1 mg/kg）和对照组（等量0.9%氯化钠溶液）,每组20例。在麻醉后（T1）及体外循环后不同时间（T2-T5）测定血浆LDH、CK-MB、c Tn I以及乳酸浓度,并监测比较2组患者的临床指标。结果体外循环后,试验组LDH比对照组低,差异有统计学意义[T4：（486.05±39.52）、（528.13±47.65）U/L,T5：（551.80±35.43）、（593.88±48.89）U/L,P〈0.01]。试验组CK-MB比对照组低,差异有统计学意义[T3：（78.39±8.27）、（88.68±16.18）U/L,P〈0.05;T4：（62.46±6.10）、（72.37±11.85）U/L,P〈0.01;T5：（47.81±8.19）、（54.56±9.21）U/L,P〈0.05]。试验组c Tn I比对照组低,差异有统计学意义[T3：（4.40±1.12）、（5.80±1.51）ng/ml,T4：（4.93±1.23）、（6.49±1.62）ng/ml,T5：（3.99±1.20）、（5.80±1.30）ng/ml,P〈0.01]。体外循环后试验组血乳酸（LAC）水平均低于对照组（P〈0.05）,而术后呼吸机、ICU住院时间以及多巴胺用量等明显低于试验组（P〈0.05或〈0.01）。结论盐酸法舒地尔可降低二尖瓣置换术患者术后血浆LDH、CK-MB、c Tn I以及LAC浓度,加强心肌保护,促进心功能的恢复,减轻术后全身炎性反应,缩短术后住院时间,具有良好的临床治疗意义。Objective To observe the therapeutic effects of fasudil hydrochloride during cardiopulmonary bypass （CPB） in patients receiving mitral valve replacement （MVR）. Methods Forty patients who received MVR were randomly divided into two groups, trial group （ n = 20） and control group （ n = 20）. The patients in trial group were given fasudil （ 1 mg/kg）, however, the patients in control group were given equivalent 0.9% sodium chloride solution. The concentrations of LDH, CK-MB, cTnI and lactic acid in plasma were detected after anesthesia （ T1 ） and at 5 different time points after CPB （T2 - TS）, moreover, the clinical parameters were analyzed and compared between two groups. Results After CPB, the levels of LDH in trial group were significantly lower than those in control group in T4 ,T5 [ （486.05 ± 39.52）U/L vs （528.13 ± 47.65 ） U/L, （551.80 ± 35.43 ） U/L vs （593.88 ± 48.89 ） U/L, respectively, P 〈 0.01 ]. The levels of CK-MB in trial group were significantly lower than those in control group in T3 ,T4,T5 [ （78.39 ±8.27）U/L vs （88.68 ± 16.18）U/L, （62.46 ± 6.10）U/L vs （72.37 ±11.85）U/L,（47.81 ±8.19）U/L vs （54.56 ±9.21） U/L,respectively, P 〈0.05 orP 〈0.01]. The levels cTnI in trial group were significantly lower than those in control group in T3, T4, T5 [ （ 4.40 ± 1. 12 ） ng/ml vs （5.80 ± 1.51 ） ng/ml, （4.93 ± 1.23 ） ng/ml vs （ 6.49 -＋ 1.62） ng/ml, （ 3.99 ＋ 1.20） ng/ml vs （5.80 ± 1.30 ） ng/ml, respectively, P 〈 0.01 ]. After CPB, the levels of lactic acid in trial group were significantly lower than those in control group （ P 〈 0.05 ）, however, postoperative breathing machine application time, the dosage of dopamine and ICU staying time in trial group were significantly lower than those in control group （ P 〈 0.05 or P 〈 0. O1 ）. Conclusion The fasudil hydrochloride can decrease the levels of LDH, CK-MB, cTnI and lactic acid in plasma of patients after receiving MVR, and can improve cardiac

关 键 词：法舒地尔 体外循环 缺血/再灌注损伤 心肌保护 心肌酶 

分 类 号：R654.27[医药卫生—外科学]