开地米丁在复杂先天性心脏病根治术中对心肌保护作用的临床研究

目的观察开地米丁（Myocardial peptide,MCP）在复杂先天性心脏病根治术中对心肌的保护作用。方法63例复杂先天性心脏病行根治术的患者,包括法乐四联症（TOF）43例右室双出口（DORV）11例,完全性心内膜垫缺损（C-ECD）9例,随机分为两组：开地米丁治疗组（MCP组,32例）和对照组（GIK组,31例）。MCP组术中给予MCP3 mg/kg,术后以3 mg/kg连用3天,对照组给予GIK液（10%葡萄糖200 ml＋50%葡萄糖100 ml＋普通胰岛素10 IU＋KCl 6 ml）,给予时间与治疗组相同。两组分别于主动脉阻断前,复灌后1 h、2 h、6 h、12 h、24 h、48 h采集患者中心静脉血,测磷酸肌酸激酶（CK）、磷酸肌酸激酶同工酶（CKMB）、心肌钙蛋白I（cTnI）。结果MCP组心脏自动复搏率高于对照组（P〈0.05）,术后多巴胺用量少于对照组（P〈0.05）,两组术后CK、CKMB和cTnI均较术前高（P〈0.05）,两组间术后CK和CKMB差异无显著性（P〉0.05）,但cTnI MCP组低于对照组（P〈0.01）。结论MCP在阻断时间较长的复杂先天性心脏病根治术中对心肌有一定的保护作用。

The Myocardial Protection of Myocardial Peptide in Complicated Congenital Heart Disease Operation

OBJECTIVE To observe myocardial protection with myocardial peptide in complicated congenital heart disease（CHD）operation.METHODS We observed the 63 cases of patients with complicated CHD,including 43 cases of TOF,11cases of DORV,9 cases of C-ECD.They were divided into two groups,MCP treatment group and GIK control group which had been infused in operation and for 3 days postoperation with the dosage of 3 mg/kg MCP or routine GIK（10% GS 200 ml＋50% GS 100 ml＋RI 10 IU＋KCl 6 ml）.The blood samples were obtained before aortic block,at 1h,2 h,6 h,12 h,24 h,48 h of post-reinfusion,to gain the level of the myocardiumase（CK and CKMB）,cTnI.RESULTS The rate of spontaneous rebeating in MCP treatment group was higher than in control one（P〈0.05）;the dosage of dopamine hydrochloride post-operation in MCP treatment group was lower than in control one（P〈0.05）;the post-operation levels of CK,CKMB and cTnI of both groups were higher than pre-operation ones（P〈0.05）.The myocardiumase of two groups was not significantly different in pre-operation and post-operation（P〉0.05）,but the cTnI was significantly different（P〈0.01）.CONCLUSION Myocardial peptide shows certain myocardial protection in long-time aortic block of complicated congenital heart disease operation.