心先安防治心肌缺血老年病人围术期心肌梗死的效果观察

目的研究环磷酸腺苷葡胺(心先安,McAMP)围术期对心肌缺血老年病人心肌梗死的预防和治疗作用。方法40例有心肌缺血基础的老年病人随机分为治疗组和对照组,每组各20例。治疗组在麻醉诱导前10min静脉注射心先安20mg,随后160mg加入100ml0.9%氯化钠注射液中持续缓慢静脉滴注;对照组静脉滴注0.9%氯化钠注射液。术中纪录心电图各导联ST段水平、MAP和HR,并计算HR与SBP的乘积(RPP);同时抽取外周静脉血检测术前、术毕、术后24h血清心肌肌钙蛋白I(cTnI)水平。结果术中对照组出现明显的ST段下降和RPP升高,与治疗组比较差异有统计学意义(P<0.05);治疗组术后cTnI水平的升高程度较对照组为低(P<0.05)。术后对照组有2例出现灶性心肌梗死。结论心先安预防和治疗老年患者围术期心肌缺血、心肌梗死具有较好的作用。

The efficacy of McAMP in preventing myocardial infarction of elderly patients with myocardial ischemia during surgery

Objective To evaluate meglumine cyclic adenosine monophosphate (McAMP) in preventing and treating acute myocardial infarction (AMI) in elderly patients with myocardial ischemia during surgery. Methods Forty patients undergoing abdominal surgery were randomly divided into two groups M group (treated with McAMP, 20 patients) and C group (without McAMP, 20 patients). All patients suffered from myocardial ischemia preoperatively, or showing ST segment depression. The M-group administered 20mg of McAMP iv 10 min before induction and McAMP 160mg also infused during operation. The C-group used 0.9%NS as substitute. The level of ST-segment, the blood pressure and heart rate (HR) were recorded , and rate-pressure product (RPP) was counted. Blood from peripheral vein was withdrawn at three points (before operation, after operation and 24h after operation) for cardiac troponin I(CTn I) marker. Results More ST-segment depression and RPP elevation were observed in C-group, which was differed significantly from M-group (P<0.05). Serum CTn I marker elevated in C-group more obvious than in M-group(P<0.05). There were two cases in C-group whom suffered from local AMI postoperatively. But there was no statistical difference between two groups. Conclusion McAMP may be of value in prevention and treatment of cardiac ischemia in elderly patients during surgery.