腺苷在心脏直视术中心肌保护作用的研究

目的观察外源性腺苷预处理和加入心停搏液两种不同给药方法在心脏直视术中的心肌保护作用。方法57例心脏直视术患者随机分为三组：对照组（组A,n=18）、腺苷预处理组（组B,n=17）、腺苷停搏液组（组C,n=22）,采集桡动脉血测定围手术期血清肌酸激酶同工酶（Creatine kinade MB,CKMB）、肌钙蛋白I（Cardiac troponin I,cTnI）、丙二醛（Malondialchehyche,MDA）水平;观察心脏停跳及复跳情况、术后机械通气时间及术后正性肌力药物的应用情况。结果三组术后CKMB、cTnI、MDA值均较术前显著升高;与组A相比：组B和组C术后多巴胺用量少,组C心脏停搏时间明显缩短,组B开放后2 h CKMB、6 h MDA、开放后各时点cTnI显著降低,组C开放后2 h、6 h CKMB及开放后各时点MDA、cTnI均显著降低;腺苷处理的两组间（B组和C组）比较：组C cTnI在16 h显著降低,其余各时间点指标无明显差异。结论外源性腺苷在心脏直视术中具有心肌保护作用,腺苷加入心停搏液中对心肌的保护作用更具显著性。

The Effects of Exogenous Adenosine on Myocardial Protection in Patients Following Open Heart Surgery with Extracorporeal Circulation

OBJECTIVE To observe the clinical effects of exogenous adenosine in open heart surgery.METHODS In a randomized prospective study,57 patients with open heart surgery were divided in three groups： control group（group A,n=18）,adenosine pretreatment group（group B,n=17） and adenosine cardioplegia group（group C,n=22）.Blood samples were taken to determine the serum concentrations of CKMB,cTnI and MDA before extracorporeal circulation,2 h,6 h and 16 h after aortic declamp.Arrest time,spontaneous resuscitation rate,the requirement for inotropics and intubation time were also evaluated.RESULTS The levels of cTnI after aortic declamp and CKMB at 2 h,MDA at 6 h and cTnI after aortic declamp were significantly lower in group B than those in group A.The levels of CKMB at 2 h and 6 h,cTnI and MDA after aortic declamp in group C were significantly lower than those in group A.The level of cTnI at 16 h after aortic declamp in group C was significantly lower than that in group B.Arrest time in group C was significantly shorter than that in group A.The requirement for inotropics in group B and group C was significantly lesser than that in group A.CONCLUSION Exogenous adenosine shows effective myocardial protection in open heart surgery,adenosine in cardioplegia solution has a better myocardial protection effect.