山莨菪碱对心脏瓣膜病心肌保护的应用研究  

Clinical Study of the effect of Anisodaminum on Myocardial Protection in Patients Undergoing Valve Replacement

作　　者：唐燕华[1] 陈朋[1] 胡大仁[1] 邓根英[1] 徐建军[1] 张润香[1] 

机构地区：[1]江西医学院第二附属医院心胸外科,江西南昌330006

出　　处：《江西医学院学报》2003年第4期28-31,共4页Acta Academiae Medicinae Jiangxi

基　　金：江西省卫生厅科学研究基金资助项目 9815 8

摘　　要：目的　观察山莨菪碱 ( 6 5 4 2 )对体外循环 (CPB)心肌缺血再灌注损伤的保护作用。方法　 38例心脏瓣膜置换术患者随机分为 6 5 4 2组 ( 19例 )和对照组 ( 19例 ) ,6 5 4 2组术中心肌灌注液中加入 6 5 4 2 ( 15mg/ 5 0 0ml) ,对照组则常规用冷晶体停搏液。通过穿刺颈外静脉或锁骨下静脉行右心房插管并分别于手术开始前、转流 30min、主动脉开放后、停机、手术结束、术后一天、术后三天抽血测定血中过氧化酶 (SOD) ,丙二醛 (MDA)和心肌酶 (乳酸脱氢酶LDH ,肌酸激酶CPK等 )的含量 ,同时观察二组患者术中心脏复跳情况和术后正性肌力药物使用情况。结果　二组术中血SOD均明显下降 ,以对照组为更显著 (P <0 .0 1) ,术后一天 6 5 4 2组血SOD含量接近术前水平 ,而对照组术后三天尚未完全恢复术前水平。二组血MDA含量则较术前上升 ,仍以对照组为明显 (P <0 .0 1) ,手术结束时开始下降 ,术后三天降至术前水平。两组血心肌酶含量术中及术后均较术前增高 ,至术后第三天仍未恢复。术中主动脉开放后 6 5 4 2组心脏自动复跳率较对照组明显增高 (P <0 .0 5 ) ,术后对照组正性肌力药物 (多巴胺等 )的使用量较 6 5 4 2组增多。结论　 6 5 4 2可有效保护SOD活性 ,抑制脂质过氧化反应 ,减轻心肌再灌注损伤。尽管如?Objective To observe the protective effect of anisodaminum(654 2) on myocardial ischemic and reperfusion injury in patients during cardiopulmonary bypass(CPB).Methods Thirty eight patients undergoing valve replacement were randomly divided into two groups: the test group( n =19)receiving 654 2 added to conventional cardioplegic(15 mg/500 ml) and contrast group( n =19)receiving conventional cardioplegic during operation.The blood samples were taken at seven different intervals for assessing the levels of surperoxide dismutase(SOD)?malondialdehyde (MDA) and LDH?CPK.Cardial resuscitation and use of positive inotropic drugs were observed.Results The levels of SOD decreased in both two groups with more markedly in control group during CPB. The levels of SOD recovered at one day after operation in the test group but at three days after operation in control group.The levels of MDA increased in two groups and more markedly in control group during CPB and restored at three days after operation. The ratio of active cardial resuscitation in 654 2 group was higher than that in control group.The amount of positive inotropic drugs in control group was more than that in 654 2 group.Conclusion This study suggests that 654 2 can protect the activity of SOD and decrease the production of MDA in order to reduce myocardio ischemic and reperfusion injury,although it need pass a long period of time for such injury to be covered.

关 键 词：山莨菪碱 体外循环 过氧化酶 丙二醛 再灌注损伤 

分 类 号：R542.5[医药卫生—心血管疾病]