磷酸肌酸钠对瓣膜置换术患者心肌缺血再灌注损伤的治疗作用

目的观察磷酸肌酸钠对二尖瓣或主动脉瓣置换术患者心肌缺血再灌注(I-R)损伤的治疗作用。方法 40例行二尖瓣或主动脉瓣置换术患者,随机分为治疗组(n=20)和对照组(n=20),治疗组在主动脉开放后10min注入磷酸肌酸钠1g(用20mL生理盐水溶解),术后1～5d每天静脉输注磷酸肌酸钠1g(用100mL生理盐水溶解),对照组注入等量生理盐水。观察和记录两组患者体外循环时间、主动脉阻断时间、体外循环辅助时间、术后呼吸机支持时间、心脏自动复跳情况,以及术后多巴胺和肾上腺素的使用情况。分别于术前、术后1d,术后5d采集患者颈内静脉血,测定肌酸激酶同工酶(CK-MB)和心肌钙蛋白I(cT-nI)浓度。结果两组体外循环时间、主动脉阻断时间、术后呼吸支持时间以及心脏自动复跳率方面比较差异均无统计学意义(P>0.05);治疗组体外循环辅助时间短于对照组(P<0.05);治疗组术后24h和48h使用肾上腺素的例数少于对照组(P<0.05)。两组CK-MB和cTnI在术后1d较术前明显升高(P<0.05),治疗组CK-MB和cTnI在术后1d和5d明显低于对照组(P<0.05)。结论磷酸肌酸钠主动脉开放后给药结合术后1～5d连续给药对二尖瓣或主动脉瓣置换术患者的心肌I-R损伤具有一定的治疗作用。

Therapeutic effects of phosphocreatine sodium on myocardial ischemia-reperfusion injury in patients undergoing cardiac valve replacement

Objective To investigate the therapeutic effects of phosphocreatine sodium on myocardial ischemia-reperfusion injury in patients undergoing mitral or aortic valve replacement.Methods Forty patients undergoing mitral or aortic valve replacement were randomly assigned into two groups:therapeutic group(n=20) and control group(n=20).The 1 g of phosphocreatine sodium dissolved in 20 ml normal saline was administrated via membrane oxygenator 10 minutes after the aortic cross-clamp release and 1 g dissolved in 100 ml normal saline injected intravenously daily from 1 to 5 day after surgery in therapeutic group.In control group the normal saline was given instead of phosphocreatine sodium.The cardiopulmonary bypass(CPB) time,aortic cross-clamp(ACC) time,CPB assisting time,administration of dopamine and adrenaline and respiratory supporting time,and automatically restoring of heart beat were observed and recorded.The blood sample were obtained form internal jugular vein before operation,first day and fifth day after operation to examine the concentration of CK-MB and cTnI.Results The incidence of automatically restoring of heart beat was the same in both group(P>0.05).The time of CPB assisting in treating group was shorter than in control group(P<0.05).The cases of adrenaline administration in treating group during 24 hr and 48 hr postoperative was lesser than in control group(P<0.05).The concentration of CK-MB and cTnI increased significantly the first day after operation(P>0.05).As compared to control group,the concentration of CK-MB and cTnI in treating group decreased significantly the first and the fifth day after operation.(P<0.05).Conclusion The administration of phosphocreatine sodium after aortic cross-clamp release combining intravenous administration from 1 to 5 day after surgery can treat the myocardial ischemia-reperfusion injury to some degree in patients undergoing mitral or aortic valve replacement.