辅酶复合物对体外循环心内直视术中心肌能量代谢的影响

目的探讨辅酶复合物对体外循环心内直视术中心肌细胞能量代谢的影响。方法先天性心脏病患者（NYHA分级为Ⅰ～Ⅱ级）40例,随机分为试验组和对照组各20例。试验组术日开胸前静脉滴注辅酶复合物（1支/10 kg）,对照组不用药。分别在术前、主动脉开放60 min时经外周静脉取血,采用化学发光法测定肌钙蛋白Ⅰ（cTnⅠ）含量。分别在主动脉阻断前和主动脉开放15 min时留取小块右心耳组织,采用高效液相色谱法测定心肌组织中三磷酸腺苷（ATP）、二磷酸腺苷（ADP）、一磷酸腺苷（AMP）、总腺苷酸（TAN）及能荷（EC）含量,同时电镜下观察心肌超微结构的变化。结果两组在缺血再灌注后,cTnⅠ含量均较缺血前显著升高（P〈0.01）,且试验组明显低于对照组（P〈0.05）;两组在缺血再灌注后的ATP、TAN和EC均显著低于缺血前,且试验组显著高于对照组（P〈0.01）;两组在缺血再灌注后的心肌细胞线粒体均较术前有不同程度的水肿,但试验组明显轻于对照组（P〈0.05）。结论辅酶复合物能有效改善心肌细胞能量代谢,维持细胞超微结构和功能,减少cTnⅠ的释放,在体外循环心肌缺血再灌注损伤中起到良好的心肌保护作用。

Effect of Coenzyme Complex on Energy Metabolism of Myocardial Cell Under Cardiopulmonary Bypass in Open Heart Surgery

Objective To study the effect of coenzyme complex cell under cardiopulmonary bypass in open heart surgery. Methods on energy metabolism of myocardial Forty patients with congenital heart disease scheduled for open heart surgery under cardiopulmonary bypass （CPB） were randomly divided into 2 groups. Coenzyme complex （ 1 bottle/10 kg） was given to the experimental group before operation. The venous blood samples were collected at two periods ： T1 ： during anesthetic induction period （ baseline） , T2 ： one hour after aorta open. The levels of cardiac troponin I （ CTn I ） were measured with chemiluminescence. Right atrial appendage specimen was taken and processed for high-performance liq- uid chromatography （HPLC） to detect the levels of ATP, ADP, AMP of myocardial tissue. Results The levels of CTnI increased significantly in the two groups after myocardial ischemia and reperfusion （ MIRI）, but the values in the experimental group were The levels of ATP, total adenine nucleotides （TAN） lower than those in the control group （ P 〈 0.05 ）. and energy charge （EC） decreased significantly in the two groups after ischemia and reperfusion, but the values in the experimental group were higher than those in the control group （P 〈 0.01 ）. The injury of myocardial cellular ultrastructure could be seen in each group after MIRI with different extent. However, more severe disorganization of myocardial cellular ultrastructure could be seen in the control. Conclusion Coenzyme complex may improve myocardial cell energy metabolism effectively, maintains the morphous and function of myocardial ultrastructure, reduces the levels of CTnI, and has the effect on myocardial protection under cardiopulmonary bypass in open heart surgery.