胸段硬膜外阻滞对非体外循环冠状动脉搭桥围术期心肌酶及心电图ST段的影响

目的 分析胸段硬膜外阻滞对非体外循环冠状动脉搭桥术（OPCAB）围术期心肌酶及心电图ST段的影响。方法 40例择期行OPCAB患者按随机分为两组：观察组为高位胸段硬膜外阻滞复合全麻组；对照组为单纯全麻组，在麻醉诱导前（T0）、术后1h（T1）、24h（T2）、48h（T3）4个时间点抽取血样测定血浆肌钙蛋白（cTnⅠ）、肌酸激酶（CK）、肌酸激酶同工酶（CK-MB）值并记录患者1-7d心电图ST段的动态变化。结果 所有患者手术经过及术后恢复顺利，无一例转为体外循环。术前两组间各项指标差异均无统计学意义（P〉0．05）。两组术后各时间点CK、CK-MB、cTnⅠ均较术前明显升高（P〈0．05）。与对照组相比，观察组术后各时间点明显降低（P〈0．05）。心电图监测显示观察组术后ST段抬高导联数3d内较术前均有所增多，在术后第4天开始下降，术后第7天已恢复至术前水平。而对照组各时间点增多均较观察组更明显，在第5天开始下降，但一直较术前高（P〈0．05）。术后两组各时间点ST段下移的导联数与术前比较差异无统计学意义（P〉0．05）。结论 硬膜外阻滞复合全麻为OPCAB围术期心肌提供良好保护作用。     

高胸段硬膜外阻滞对合并冠心病患者腹部手术的应用研究

目的 观察行上腹部手术的冠心病患者围手术期高胸段硬膜外阻滞防止心肌缺血的效果.方法 对20例择期行上腹部手术的冠心病患者,随机分为两组,每组各10例.治疗组予以高胸段硬膜外阻滞联合全身麻醉的方法,术毕予经硬膜外镇痛泵镇痛,观察其围手术期血流动力学指标,ECG变化,血清肌钙蛋白I、肌红蛋白、肌酸磷酸激酶同工酶(CPK-MB)定性变化和采用视觉模拟评分法评估术后镇痛效果.并与采用单纯全身麻醉的方法,术后予经静脉镇痛泵镇痛的对照组进行比较.结果 治疗组比对照组血流动力学指标更平稳(P＜0.05);对照组ECG示ST段压低幅度的总和在术毕拔管时和术后10 h时增加明显且高于治疗组同时间点(P＜0.05);对照组术后10、24 h时肌钙蛋白I阳性和术后24 h CPK-MB阳性率要明显高于治疗组同时间点(P＜0.05);治疗组术后镇痛效果要优于对照组(P＜0.05).结论 高胸段硬膜外阻滞联合全身麻醉可以减少行上腹部手术的冠心病患者围手术期心病肌缺血性损伤的发生.     

胸段硬外复合全麻对老年术中血流动力学及血糖的影响

目的观察与探讨胸段硬膜外阻滞复合全身麻醉对高龄患者术中血流动力学及血糖的影响.方法50例拟行上腹部手术的高龄患者,随机分为硬膜外阻滞复合全麻组(A组,n=25)和全麻组(B组,n=25),观察术中血流动力学及血糖的变化.结果A组术中血流动力学及血糖均较稳定,B组在气管插管和拔管时平均动脉压(MAP)明显升高,心率(HR)明显增快(P＜0.05),血糖于术终较术前明显升高(P＜0.05).结论硬膜外阻滞复合全麻能有效地抑制术中应激反应,维持血流动力学及血糖的稳定.     

全麻复合硬膜外阻滞行腹腔镜胆囊切除术对老年患者应激反应的影响

目的 研究全麻复合硬膜外阻滞行腹腔镜胆囊切除术对老年患者应激的影响,为全麻复合硬膜外麻醉的临床应用提供理论依据.方法 40例ASA Ⅰ～Ⅱ级择期行腹腔镜胆囊切除手术病人(年龄＞65岁),随机双盲分为全麻组(A组)和全麻复合硬膜外阻滞组(B组),每组20例.并于麻醉前(T1),气管插管后5 min (T2),气腹后5min (T3),术毕前5min (T4),拔管后5 min (T4)抽静脉血,检测血浆标本中血糖浓度、皮质醇、血管紧张素Ⅱ、白介素-6(IL-6).采用SPSS 10.0及SigmaPlot统计绘图软件分析处理数据.结果 A组血流动力学气管插管后较B组波动大(P＜0.05).A组在T2、T3、T5时血糖浓度显著高于B组(P＜0.05).两组血管紧张素Ⅱ在麻醉后各时间段相比有显著性差异(P ＜0.05);两组T4、T5的IL-6浓度均明显高于T2时的水平(P＜0.05);组间比较,B组T4、T5时IL-6的浓度明显低于A组(P＜0.05).结论 全麻复合硬膜外阻滞组对老年患者应激反应的影响小于全麻组.     

血糖对急性心肌梗死患者预后和经皮冠状动脉介入治疗后心肌灌注的影响

目的 探讨血糖对急性心肌梗死(AMI)患者预后和经皮冠状动脉介入(PCI)治疗后心肌灌注的影响.方法 选取接受直接PCI治疗的AMI患者106例,将既往有糖尿病病史或者无糖尿病病史但入院时第1次随机血糖≥7.8 mmol/L者列为高血糖组(49例),其余患者列为正常血糖组(57例).比较两组患者术后梗死相关动脉(IRA)的TIMI血流分级、术前及术后各导联ST段抬高的平均值、术后ST段回落程度及住院期间心血管不良事件发生率.结果 高血糖组发病到就诊的时间长(P＜0.05),无痛性心肌梗死发生率及心血管不良事件发生率比正常血糖组高(P＜0.05);两组PCI术后60 min各导联ST段抬高平均值及术后ST段回落程度比较差异有统计学意义(P＜0.05);高血糖组多支血管病变、弥漫性病变比例较正常血糖组高(P＜0.05),左室射血分数明显降低(P＜0.05).结论 既往有糖尿病病史或入院后随机血糖升高的AMI患者,行急诊PCI治疗后的心肌灌注较差,进而影响心功能,增加住院期间心血管不良事件的发生率.     

ST段抬高型急性心肌梗死相关动脉中应用替罗非班前后肌酸激酶同工酶和J波的变化及意义

目的 评价ST段抬高型急性心肌梗死(STEMI)患者直接经皮冠状动脉介入治疗(PCI)过程中对梗死相关动脉(IRA)注射替罗非班的有效性及安全性.方法 IRA使用替罗非班组:106例STEMI住院患者在PCI术中置入支架后,经指引导管向IRA注射盐酸替罗非班500 μg;静脉使用替罗非班组:106例STEMI住院患者置入支架术后24h静脉泵入盐酸替罗非班0.1 μg/(kg· min).检测两组患者PCI术前、术后24 h外周血肌酸激酶同工酶(CK-MB)浓度和12导联心电图,分别记录5个导联组(分别为Ⅱ、Ⅲ、avF组,Ⅴ1、Ⅴ2组,Ⅴ3、Ⅴ4组,Ⅴ5、Ⅴ6组及Ⅰ、avL组).根据时程或波幅将J波分为3个等级:小J波、大J波、巨大J波.结果 PCI术后24h,两组CK-MB峰值较术前降低,差异有统计学意义(P＜0.05);IRA使用替罗非班组CK-MB峰值(52.1 U/L)低于静脉使用替罗非班组(84.2 U/L),差异有统计学意义(P＜0.05); IRA使用替罗非班组J波个数(86)较术前(203)减少,差异有统计学意义(P＜0.05);静脉使用替罗非班组J波个数(192)与术前(202)比较,差异无统计学意义(P＞0.05);两组小J波比例有所增加,大J波及巨大J波比例有所下降.结论 STEMI患者PCI过程中,IRA注射替罗非班对改善冠脉再灌注有效且安全.     

心肌肌钙蛋白Ⅰ与肌酸激酶同功酶-MB在小儿心肌炎诊断中的应用

目的:探讨心肌肌钙蛋白Ⅰ (cTnI)与肌酸激酶同功酶-MB (CK-MB)在小儿心肌炎诊断中的应用.方法:选择2008年6月～2010年12月急性心肌炎患儿92例,同时选择86例健康儿童作为对照组,入院时和住院2周检测患儿cTnI和CK-MB水平,比较患儿入院时、治疗2周时cTnI和CK-MB水平.结果:心肌炎患儿cTnI和CK-MB水平较正常儿童显著升高(P＜0.05);cTnI检测异常率(76.1％)显著高于CK-MB检测异常率(50.0％)(P＜0.05);治疗2周后,CK-MB恢复正常,而cTnI水平仍显著高于对照组(P＜0.05);心电图异常者,cTnI检测异常率(90.5％)显著高于CK-MB检测异常率(76.2％)(P＜0.05).结论:cTnI、CK-MB对小儿心肌炎的诊断均较敏感,其中cTnI对心肌损害的敏感性及特异性高于CK-MB;cTnI诊断时间窗宽于CK-MB,特异性也高于心肌酶学检查.     

全麻复合硬膜外阻滞用于老年肝胆管取石术

目的评价全麻复合硬膜外阻滞对老年肝胆管结石手术病人循环及应激反应状态的影响.方法 60例ASAⅠ～Ⅱ级择期肝胆管结石手术老年病人,随机分为单纯全麻组(对照组)和全麻复合硬膜外阻滞组(研究组).观察记录循环指标、全麻药用量、麻醉后清醒时间.结果对照组病人全麻插管时应激反应重,血压、心率较插管前显著增加(P＜0.05),组间比较差异显著(P＜0.05),全麻药用量明显高于研究组(P＜0.01).麻醉清醒时间长于研究组(P＜0.05).结论全麻复合硬膜外阻滞用于老年肝胆管取石术病人可减轻应激反应,循环状态稳定,安全可行.     

七氟醚全麻诱导的临床效果及对患者术后认知功能的影响

目的 探讨七氟醚对老年手术患者的全麻诱导效果及对术后认知功能的影响.方法 将126例普外科老年手术患者随机分为两组,分别采用七氟醚吸入全麻诱导(A组)和丙泊酚静脉全麻诱导(B组),比较两组的麻醉效果及术后认知功能.结果 A组意识消失时间、睫毛反射消失时间和气管插管时间均显著长于B组(P＜0.05).B组T1时的HR较T0时显著减慢(P＜0.05);与T1时比较,A、B组T2 ～T4时的SBP、DBP显著升高(P＜0.05),B组HR明显加快(P＜0.05);T,时A组SBP、DBP和HR均明显高于B组(P＜0.05).两组术后1h、6h的MMSE评分均较术前24 h明显降低(P＜0.05);A组术后1h、6h的MMSE评分明显低于B组(P＜0.05).结论 七氟醚全麻诱导用于老年手术较丙泊酚全麻诱导更为平稳、快速,对患者术后认知功能仅产生一过性影响.     

曲美他嗪对非体外循环冠状动脉旁路移植术患者B型钠尿肽和心肌肌钙蛋白Ⅰ的影响

目的 观察非体外循环冠状动脉旁路移植术(OPCAB)患者外周血中B型钠尿肽(BNP)和心肌肌钙蛋白Ⅰ(cTnI)在围手术期的变化情况及其在心脏外科的临床应用价值,并探讨曲美他嗪预处理对心肌的保护效果.方法 将103例择期行OPCAB的冠心病患者按随机数字表法分为曲美他嗪组(52例)和对照组(51例).分别于术前及术后24h、72 h、7 d时检测外周血BNP和cTnI水平.结果 曲美他嗪组术后24 h、72 h、7dBNP水平[分别为(224.5±12.0)、(331.2±22.6)、(82.4±3.3)ng/L]均低于对照组[分别为(294.7±11.8)、(383.9±28.3)、(112.4±12.5)ng/L](P＜0.05);曲美他嗪组术后24 h、72 h、7 d cTnI水平[分别为(0.21±0.04)、(1.32±0.49)、(0.26±0.04)μg/L]均低于对照组[分别为(1.20±0.13)、(2.35±0.54)、(0.75±0.21)μgL](P＜0.05);BNP水平术后24 h即有上升,72 h达峰值,并维持至术后7d.BNP与cTnI呈显著正相关(r=0.635,P＜0.05),与左室射血分数(LVEF)呈显著负相关(r=-0.674,P＜0.01).结论 通过OPCAB术后外周血BNP和cTnI水平升高可以了解患者心功能状况,曲美他嗪可降低OPCAB患者术后BNP和cTnI的释放.     

Comparison of erythrocyte and skeletal muscle creatine accumulation following creatine loading

This study attempted to determine the relationship between creatine (Cr) accumulation in human skeletal muscle and erythrocytes following Cr supplementation. If a strong relationship exists, a blood test might provide a practical, less invasive alternative than muscle biopsy for evaluating cellular Cr accumulation. Eighteen active, but not well-trained males were supplemented with Cr (4 x 5 g/d) for 5 d. Muscle biopsies (vastus lateralis) were obtained pre- and post-loading and analyzed for Cr, phosphocreatine (PCr), and total Cr (TCr) content. Venous blood was also drawn at these times to determine erythrocyte Cr concentrations. Muscle Cr, PCr, and TCr concentrations were elevated (P < 0.05) by 39.8%, 7.5%, and 20.1% respectively following supplementation. Erythrocyte Cr concentrations were also elevated (P < 0.01) following the loading period, although to a greater relative degree than tissue concentrations (129.6%). Pre- and post-loading erythrocyte Cr concentrations were poorly and nonsignificantly correlated with that observed in skeletal muscle. Further, loading-mediated increases in erythrocyte Cr concentrations were poorly correlated with elevations in muscle Cr (r = 0.07), PCr (r = 0.06) or TCr (r = 0.04) concentrations. Erythrocyte Cr concentrations can be augmented by 5 d of Cr supplementation, however, this elevation does not reflect that observed in skeletal muscle obtained by muscle biopsy. Consequently, erythrocyte response to Cr loading is not a reliable measure of skeletal muscle Cr/TCr accumulation.     

Skeletal muscle total creatine content and creatine transporter gene expression in vegetarians prior to and following creatine supplementation

This study examined the effect of vegetarianism on skeletal muscle total creatine (TCr) content and creatine transporter (CreaT) gene expression, prior to and during 5 d of Cr supplementation (CrS). In a double-blind, crossover design, 7 vegetarians (VEG) and nonvegetarians (NVEG) were assigned Cr or placebo supplements for 5 d and after 5 wk, received the alternative treatment. Muscle sampling occurred before, and after 1 and 5 d of treatment ingestion. Basal muscle TCr content was lower (P < 0.05) in VEG compared with NVEG. Muscle TCr increased (P < 0.05) throughout the Cr trial in both groups but was greater (P < 0.05) in VEG compared with NVEG, at days 1 and 5. CreaT gene expression was not different between VEG and NVEG. The results indicate that VEG have a lower muscle TCr content and an increased capacity to load Cr into muscle following CrS. Muscle CreaT gene expression does not appear to be affected by vegetarianism.     

Effect of creatine supplementation and a lacto-ovo-vegetarian diet on muscle creatine concentration

The purpose of this investigation was to examine the effects of preceding oral creatine monohydrate with a lacto-ovo-vegetarian diet on muscle creatine concentration. Thirty-two healthy men, who regularly consumed an omnivorous diet, were randomly assigned to consume a weight maintaining, lacto-ovo-vegetarian (LOV; n = 16) or omnivorous (Omni; n = 16) diet for 26 days. In addition to their assigned diet, on day 22 of the study, subjects were assigned in a double-blind manner to receive either creatine monohydrate (CM; 0.3 g kg d 1 + 20 g Polycose) or an equivalent dose of placebo (PL) for 5 days. There were no significant differences between the LOV and Omni groups at baseline with respect to age, height, and weight. The results demonstrated that consuming a LOV diet for 21 days was an effective procedure to decrease muscle creatine concentration (p <.01) in individuals who normally consume meat and fish in their diet. However, muscle total creatine (TCr) following creatine supplementation did not differ statistically between LOV and Omni diet groups (148.6 4.5 vs. 141.7 4.5 mmol kg-1 d.m.).     

Elevated creatine kinase and malignancy

Increased serum levels of CK isoenzymes variously signal heart, brain, or skeletal muscle damage. They may also be markers for advanced tumors with poor prognosis.     

Effect of alpha-lipoic acid combined with creatine monohydrate on human skeletal muscle creatine and phosphagen concentration

Alpha-lipoic acid has been found to enhance glucose uptake into skeletal muscle in animal models. Studies have also found that the co-ingestion of carbohydrate along with creatine increases muscle creatine uptake by a process related to insulin-stimulated glucose disposal. The purpose of this study was to determine the effect of alpha-lipoic acid on human skeletal muscle creatine uptake by directly measuring intramuscular concentrations of creatine, phosphocreatine, and adenosine triphosphate when creatine monohydrate was co-ingested with alpha-lipoic acid. Muscle biopsies were acquired from the vastus lateralis m. of 16 male subjects (18-32 y) before and after the experimental intervention. After the initial biopsy, subjects ingested 20 g x d(-1) of creatine monohydrate, 20 g x d(-1) of creatine monohydrate + 100 g x d(-1) of sucrose, or 20 g x d(-1) of creatine monohydrate + 100 g x d(-1) of sucrose + 1000 mg x d(-1) of alpha-lipoic acid for 5 days. Subjects refrained from exercise and consumed the same balanced diet for 7 days. Body weight increased by 2.1% following the nutritional intervention, with no differences between the groups. There was a significant increase in total creatine concentration following creatine supplementation, with the group ingesting alpha-lipoic acid showing a significantly greater increase (p < .05) in phosphocreatine (87.6 --> 106.2 mmol x kg(-1) dry mass [dm]) and total creatine (137.8 --> 156.8 mmol x kg(-1) dm). These findings indicate that co-ingestion of alpha-lipoic acid with creatine and a small amount of sucrose can enhance muscle total creatine content as compared to the ingestion of creatine and sucrose or creatine alone.     

Parallel increases in phosphocreatine and total creatine in human vastus lateralis muscle during creatine supplementation

Short-term creatine supplementation is reported to result in a decreased ratio of phosphocreatine (PCr) to total creatine (TCr) in human skeletal muscle at rest. Assuming equilibrium of the creatine kinase reaction, this decrease in PCr:TCr implies increased cytoplasmic ADP and decreased Gibbs free energy of ATP hydrolysis in muscle, which seems contrary to the reported ergogenic benefits of creatine supplementation. This study measured changes in PCr and TCr in vastus lateralis muscle of adult men (N = 6, 21-35 y old) during and 1 day after 5 d of creatine monohydrate supplementation (0.43 g.kg body weight(-1).d(-1)) using noninvasive 31P and 1H magnetic-resonance spectroscopy (MRS). Plasma and red-blood-cell creatine increased by 10-fold and 2-fold, respectively, by the third day of supplementation. MRS-measured skeletal muscle PCr and TCr increased linearly and in parallel throughout the 5 d, and there was no significant difference in the percentage increase in muscle PCr (11.7% +/- 2.3% after 5 d) vs. TCr (14.9% +/- 4.1%) at any time point. The results indicate that creatine supplementation does not alter the PCr:TCr ratio, and hence the cytoplasmic Gibbs free energy of ATP hydrolysis, in human skeletal muscle at rest.