心肌肽素在心脏手术中对心肌的保护作用的临床研究

目的:考察心脏瓣膜替换术和冠状动脉旁路移植术(CABG)患者在体外循环停跳液中使用心肌肽素的安全性及对心肌的保护作用。方法:选择心脏瓣膜替换术患者44例(瓣膜替换组,又随机分为对照患者、用药患者各22例),CABG患者65例(CABG组,又随机分为对照患者33例、用药患者32例)。2组用药患者在麻醉后,静脉滴注心肌肽素1 mg/kg,30分钟给药完毕;第1次灌注时在停跳液中一次性加入心肌肽素2 mg/kg。2组对照患者给予相应的甘露醇。观察围术期血流动力学,心肌组织形态学,心肌酶学及肌钙蛋白含量的变化。结果:所有受试患者均顺利完成试验,未见明显不良反应,均康复出院。CABG组心肌组织形态学:用药患者在用药前心肌组织病变分值较对照患者显著升高(P<0.01),而用药后较对照患者显著降低(P<0.01);用药患者体外循环后心肌组织病变分值较体外循环前显著降低(P<0.01);而对照患者体外循环后心肌组织病变分值较体外循环前显著升高(P<0.01)。瓣膜替换组心肌组织形态学:体外循环前心肌组织病变分值用药患者虽高于对照患者,但无统计学意义;体外循环后用药患者显著低于对照患者(P<0.01);体外循环后对照患者心肌组织病变分值较体外循环前显著升高(P<0.01),用药患者虽有降低,但无统计学差异(P>0.05)。结论:心肌肽素在心脏瓣膜替换术和CABG患者体外循环停跳液中使用是安全的,而且对心肌有一定保护作用。

A Clinical Study on Myocardial Protection of Cardiomyopeptidin in Cardiac Surgery

Objective: To investigate the safety and myocardial protection effect of cardiomyopeplidin in patients undergoing valvular surgery or coronary artery bypass grafting (CABG) surgery. Methods: Forty-four patients undergoing valvular surgery and 65 patients undergoing CABG were divided into drug group and control group in a randomized, controlled and double-blind study. In drug group, cardiomypeptidin 1 mg/kg was intravenously infused continuously during a period of 30 minutes after anesthesia and cardiomypeptidin was given 2 mg/kg in cardioplegic solution at first filling. Corresponding mannitol was given in the control group. The changes of myocardial morphology, perioperative hemo-dynamics and myocardial enzymology, and the quantity of troponin were observed. Results: All patients completed the trial and were discharged without obvious side effects. The changes of myocardial morphology in patients with coronary artery disease ( CAD) were as follows; Myocardial lesion liter in the drug group was dramatically higher before cardiopulmonary bypass ( CPB) ( P < 0. 05), but dramatically lower after CPB (P < 0. 01) compared with the control group. After cardiopulmonary bypass,myocardial lesion liter in the drug group was dramatically decreased (P <0. 01 ) ,but not in the control group (P < 0. 01). The changes of myocardial morphology in the valvular disease subgroup were: Myocardial lesion tiler in the drug group was slightly higher than in the control group before CPB,but dramatically lower than in the control group after CPB (P < 0. 01). Myocardial lesion tiler was dramatically increased in ihe control group after CPB (P < 0. 01), but the decrease in the drug group was not significant ( P > 0. 05). Conclusion: The use of cardiomyopeptidin in the cardioplegic solution in the patients undergoing valvular surgery or CABG is safe and has protective effect for myocardium.