心脏瓣膜置换术中应用1,6-二磷酸果糖的心肌保护作用研究

目的探讨1,6-二磷酸果糖（FDP）在心脏瓣膜置换术中对心肌的保护作用。方法瓣膜置换术患者60例,随机分为实验组和对照组,每组30例。实验组于CPB前分别从中心静脉滴入和经心肌保护液中加入FDP150 mg/kg,对照组则以等量生理盐水代替。两组于围术期不同时点中心静脉采血检测心肌肌钙蛋白I（cTnI）、肌酸激酶同功酶（CKMB）、乳酸脱氢酶（LDH）、肌红蛋白（MYO）;临床观察心脏自动复跳情况、心电图S-T段改变、正性肌力药用量、术后拔管时间、ICU滞留时间等项目;在电境下观察心肌超微结构的变化。结果两组cT-nI、CKMB、LDH、MYO于主动脉开放后逐步升高,明显高于阻断前（P〈0.05）。实验组这些指标升幅均小于对照组,cTnI、CKMB于开放升主动脉后30 min及CPB停机后6 h显著低于对照组（P〈0.05）,且实验组心脏自动复跳率高、术中S-T段改变轻微、正性肌力药用量少、ICU滞留时间短;电镜亦显示实验组心肌超微结构损伤明显轻于对照组。结论1,6-二磷酸果糖在心脏瓣膜置换术中具有良好的心肌保护作用。

Myocardial Protective Effects of Fructose-1, 6-bisphosphate on the Patients Undergoing Cardiac Valve Replacement Surgery

OBJECTIVE To evaluate protective effects of Fructose-1,6-bisphosphate（FDP） on myocardial structure and function during cardiac valve replacement surgery.METHODS 60 patients undergoing cardiac valve replacement were randomly and double-blinded selected to a treatment group and a control group（30 cases for each）.Before initiation of cardiopulmonary bypass（CPB）,FDP was administered in the treatment group at dosage of 150 mg/kg by the central vein and mixed with cardioplegia solution in CPB line,respectively.As compared with FDP,in control group the same volume of normal saline was given into the patients.Plasma concentrations of cardiac biomarkers including Cardiac troponin I（cTnI）,Creatine kinase MB isoenzyme（CKMB）,Lactate dehydrogenase（LDH）,Myoglobin（MYO） were measured at different time points in the two groups,meanwhile,Clinical data including heart resuscitation,ST-segment deviations,dosages of positive inotropic agent,time of ICU stay were recorded.Microstructures of myocardial cell were scanned by electrical microscope.RESULTS The plasma concentrations of the cardiac biomarkers after clamping off the aorta in both groups were significantly higher than those before onset of clamping the aorta（P〈0.05）,the concentrations of all the cardiac biomarkers measured in the treatment group were much lower than those in control group.cTnI、CKMB showed significant lower level at time points of 30 minutes after clamping off the aorta and 6 hours after the end of CPB（P〈0.05）.Clinical observations showed that treatment group had successful heart resuscitation,mild ST-segment deviations,less positive inotropic support and shorter length of ICU stay.The myocardial microstructures were found less damages in treatment group than in control group.CONCLUSION The findings suggest that FDP plays substantial,protective roles on myocardial structure and function during cardiac valve replacement surgery.