1,6-二磷酸果糖和左旋精氨酸对心内直视手术期间血清心肌肌钙蛋白T的影响

目的探讨1,6-二磷酸果糖(FDP)和左旋精氨酸(l-Arg)及其联合用药对体外循环期间心肌缺血再灌注损伤的保护作用。方法拟行心内直视手术的先天性心脏病患者40例,随机分为对照组(A组)、l-Arg组(B组)、FDP组(C组)和联合用药组(D组),每组10例。B组于主动脉开放后给予l-Arg 200 mg／kg;C组于主动脉阻断前给予FDP 200 mg/kg;D组联合应用两种药物。分别于主动脉插管时,主动脉开放30 min、2 h、6 h时检测血清心肌肌钙蛋白T(cTnT)、丙二醛(MDA)含量和超氧化物歧化酶(SOD)活性。结果各用药组与对照组比较,可显著降低血浆cTnT和MDA的上升幅度,提高SOD活性(P<0．05),且D组与B组、C组比较可显著降低血浆cTnT的上升幅度(P< 0．05)。结论1,6-二磷酸果糖和左旋精氨酸对心内直视手术中的心肌保护有良好的作用,联合应用优于两药单用。

Effect of fructose 1,6-diphosphate plus l-arginine on the change of cardiac troponin T during open heart surgery with cardiopulmonary bypass

Objective To investigate the protective effects of fructose 1,6-diphosphate(FDP) plus l-arginine(l-Arg) on myocardial ischemia reperfusion injury during open heart surgery with cardiopulmonary bypass (CPB). Methods Forty patients suffering from congenital ventricular septal defect or alrial septal defect were randomly divided into the control group and the treated groups (l-Arg, FDP,l-Arg plus FDP), 10 cases in each group .l- Arg (200 mg/kg) was administered into blood after aortic-off clamping in l-Arg group. FDP (200 mg/kg) was administered into blood before aortic-clamping in FDP group.And both l-Arg and FDP were administered into blood in l-Arg plus FDP group.Before aortic-clamping and 30 minutes,2 hours, 6 hours after aortic-off clamping,blood samples were taken to measure the levels of cardiac troponin T (cTnT), malondialdehyde (MDA) and the activity of superoxide dismulase (SOD). Results The treated groups could significantly lower the rising tendency of cTnT, MDA and increase the activity of SOD as compared with the control group (P < 0.05 ) . The group of l-Arg plus FDP could significantly lower the rising tendency of cTnT as compared with l-Arg group and FDP group (P < 0.05). Conclusion l-Arg plus FDP has notable protective effect on ischemia reperfusion myocardium during open heart surgery with CPB.which is better than using the two medicines separately.