腺苷与双嘧达莫预适应在心肺转流中的心肌保护作用

目的 观察腺苷与核苷转运抑制剂双嘧达莫药理性预适应在心脏直视术心肺转流(CPB)中对心肌的保护作用.方法 53例心脏瓣膜置换术患者随机分为四组:腺苷组转流前微量泵入腺苷;联合组术前口服双嘧达莫,余同腺苷组;双嘧达莫组仅口服双嘧达莫;对照组泵入同体积生理盐水.分别于转流前、主动脉开放后2、6、16 h采集患者桡动脉血,测血清肌酸激酶同功酶(CK-MB)、肌钙蛋白I(cTn I)、丙二醛(MDA);观察术后机械通气时间及术后正性肌力药物的应用.结果 腺苷组术后多巴胺用量少,开放后2 h CK-MB、6 h MDA,开放后cTn I均较对照组显著降低,联合组开放后CK-MB、cTn I、MDA均降低.结论 外源性腺苷预适应有显著心肌保护作用,核苷转运抑制可增强这一作用,内源性腺苷对心肌保护的效果不明显.

Protective effect of pharmacological preconditioning with adenosine and dipyridamole on myocardium during CPB

Objective To observe the effect of adenosine and dipyridamole preconditioning on myocardial protection during cardiopulmonary bypass(CPB).Method Fifty-three patients undergoing cardiac valve replacement were randomized into three matched groups.Group Dip(n=12)received dipyridamole alone and group Ado(n=13)adenosine before CPB,group Ado+Dip(n=14)both of the two drugs and group C(n=14)without dipyridamole and adenosine.Blood samples were taken to determine the serum concentrations of CK-MB,cTnI and MDA before CPB at 2,6 and 16 h after opening aortic clamp.Results The levels of cTnI after surgery and CK-MB at 2 h,MDA at 6 h after opening aortic clamp were significantly lower in group Ado than those in group C.The levels of CK-MB,cTnI and MDA after aortic opening clamp in group Ado+Dip were significantly lower than those in group C.Conclusion Exogenous adenosine preconditioning is effective in myocardial protection,which can be enhanced by blocking the nucleoside transporter with dipyridamole.whereas endogenous adenosine is likely ineffective.