心脏瓣膜置换术中心脏复跳前主动脉根部灌注腺苷对心肌的保护作用  

The Effect of Adenosine Perfusion Via the Aortic Root before Heart Re-beating on Myocardial Protection in Patients Undergoing Cardic Valve Replacement

作　　者：梁湘源 张希[2] LIANG Xiang-yuan;ZHANG Xi(Department of Cardiac Surgery,the Affiliated Jiangmen Hospital,Sun Yatsen University,Jiangmen 529000,China;Department of Cardiac Surgery,the First Affiliated Hospital,Sun Yatsen University,Guangzhou 510080,China)

机构地区：[1]中山大学附属江门医院心脏外科,广东省江门市529000 [2]中山大学附属第一医院心脏外科,广东省江门市529000

出　　处：《中国心血管病研究》2020年第2期123-126,共4页Chinese Journal of Cardiovascular Research

基　　金：江门市科技立项项目(2012002)。

摘　　要：目的研究在心脏瓣膜置换术中心脏复跳前主动脉根部灌注腺苷对心肌的保护作用.方法选择中山大学附属江门医院心脏外科2018年1~10月期间42例行心脏瓣膜置换术患者,随机分为两组,腺苷组在心脏瓣膜置换完成后,心脏复跳前主动脉根部灌注入外源性腺苷,对照组心脏复跳前不灌注外源性腺苷,按照常规处理.术前、主动脉开放后4 h、12 h、24 h采集患者桡动脉血,测心肌型肌酸激酶同工酶(CK-MB)、肌钙蛋白I(cTnI).观察心脏停跳情况,术后机械通气时间及术后正性肌力药物的应用情况,心肌超微结构的改变.结果腺苷组术后多巴胺用量较对照组减少[(2.45±1.43)μg·kg^-1·min^-1比(4.70±0.99)μg·kg^-1·min^-1,P<0.05].腺苷组CK-MB水平在主动脉开放后4 h、12 h较对照组低[(35.47±15.23)U/L比(48.58±17.54)U/L,(41.12±14.31)U/L比(59.15±27.49)U/L,P<0.05].cTnI水平在主动脉开放后4 h、12 h、24 h较对照组低[(0.62±0.3)μg/L比(0.91±0.31)μg/L,(0.72±0.28)μg/L比(0.98±0.31)μg/L,(0.36±0.23)μg/L比(0.70±0.26)μg/L,P<0.05].透射电镜见腺苷组肌细胞轻度肿胀,核形尚规则,无核固缩,线粒体轻度肿胀,心肌损伤较对照组明显减轻.结论在心瓣膜置换术中心脏复跳前主动脉根部灌注腺苷能显著提高心肌保护效果.Objective To observe the clinical effects of adenosine perfbsion via the aortic root before heart re-beating in cardie valve replacement.Methods From January to October 2018,a total of 42 patients undergoing cardie valve replacement in the Affiliated Jiangmen Hospital of Sun Yatsen University were divided randomly into two groups:adenosine group(n=20)received aortic root perfusion of exogenous adenosine,control group(n=22)not received adenosine.Blood samples were taken to determine the serum concentrations of creatinine kinase-MB isoenzyme(CK-MB)and cardiac troponin I(cTnl)before cardiopulmonary bypass,4 hours,12 hours and 24 hours after aortic declamping.Biopsies of right atrium were taken to be analyzed under electron microscope.Results The dopamine usage was significantly lower in the adenosine group than control group[(2.45±1.43)μg·kg^-1,•min^-1 vs.(4.70±0.99)·kg^-1•min^-1,P<0.05].The levels of CK-MB at 4 hours and 12 hours after aortic declamping were significantly lower in the adenosine group than control group[(35.47士15.23)U/L vs.(48.58±17.54)U/L,(41.12±14.31)U/L vs.(59.15±27.49)U/L,P<0.05].And cTiiIat4h ours,12 hours and 24 hours were significantly lower in the adenosine group than control group[(0.62士0.3)|ig/L vs.(0.91±0.31)叫/L,(0.72士0.28)U/L vs.(0.9±土0.31)ng/L,(0.36土0.23)μg/L vs.(0.70士0.26)μg/L,P<0.05].Ultrastructure changes were slighter in the adenosine group than in the control group.Conclusion Adenosine perfusion via the aortic root before heart re-beating shows effective myocardial protection in patients undergoing cardie valve replacement.

关 键 词：腺苷 心肌保护 心脏瓣膜置换术 

分 类 号：R654.2[医药卫生—外科学]