左卡尼汀对心内直视术患者心肾缺血再灌注损伤的影响

目的 分析左卡尼汀对心内直视术患者心肾缺血再灌注损伤的影响.方法 收集2011年2月—2015年1月接受体外循环心脏瓣膜置换术治疗的76例患者的临床资料,其中35例给予常规扩张冠状动脉、抗凝及降脂干预,作为对照组,41例在常规治疗基础上加用左卡尼汀,作为观察组.比较手术前后两组血肌酐(Cr)、尿素氮(BUN)、尿微量白蛋白(UAE)、β2-微球蛋白(β2-MG)、超氧化物歧化酶(SOD)、丙二醛(MDA)、肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)等指标的变化,记录手术前后两组心脏指数(CI)和左心室射血分数(LVEF)的变化.结果 两组术后CK、CK-MB、CI、LVEF、BUN、Cr、UAE、β2-MG和MDA均较术前上升,但SOD较术前降低(P<0.05).术后观察组CK、CK-MB、BUN、Cr、UAE、β2-MG和MDA均低于对照组(P<0.05);而CI、LVEF和SOD均高于对照组(P<0.05).两组均未出现不良反应.结论 左卡尼汀可减轻心内直视术患者心、肾等组织缺血再灌注损伤,降低氧化应激反应,保护心、肾功能.

Effect of Levocarnitine on Cardiac and Renal Ischemia-reperfusion Injury in Patients Undergoing Open-heart Surgery

Objective To analyze effect of Levocarnitine on cardiac and renal ischemia-reperfusion injury in pa-tients undergoing open-heart surgery. Methods Clinical data of 76 patients who received cardiopulmonary bypass heart valve replacement between February 2011 and January 2015 was collected. Among them, 35 patients ( control group) re-ceived of routine treatments such as coronary dilatation, anticoagulation and interventions of reduction blood fat, while 41 patients ( observation group) were added with Levocarnitine on the basis of routine treatment. Changes of indexes such as serum creatinine (Cr), blood urea nitrogen (BUN), microalbuminuria (UAE), beta2-microglobulin (β2-MG2), super-oxide dismutase ( SOD) , malondialdehyde ( MDA) , creatine kinase ( CK) , creatine kinase isoenzyme ( CK-MB) were compared between the two groups before and after operation. Changes of cardiac index ( CI) and left ventricular ejection fraction ( LVEF) were recorded before and after operation in two groups. Results Values of CK, CK-MB, CI, LVEF, BUN, Cr, UAE,β2-MG and MDA were increased, while SOD value was lower after operation compared with those before operation in the two groups (P<0. 05). After operation in observation group, values of CK, CK-MB, BUN, Cr, UAE,β2-MG and MDA were lower (P<0. 05), while values of CI, LVEF and SOD were higher than those in the control group (P<0. 05). No adverse reactions were found in the two groups. Conclusion Levocarnitine can relieve cardiac and re-nal ischemia-reperfusion injury, reduce oxidative stress reactions and protect cardiac and renal function for patients under-going open-heart surgery.