磷酸肌酸钠对体外循环下房室间隔缺损修补术患儿心肌能量代谢和心肺功能的影响

目的:探讨磷酸肌酸钠液冷晶体停跳液对体外循环下房室间隔缺损修补术患儿心肌能量代谢和心肺功能的影响。方法:采用前瞻性随机对照研究。选取在南方医科大学附属佛山医院接受体外循环下行手术治疗的房室间隔缺损患儿48例，采用随机数字表法分为试验组和对照组，每组24例。对照组患儿男14例、女10例，年龄（7.2±3.4）岁，体质量（...

Effect of sodium creatine phosphate on myocardial energy metabolism and cardiopulmonary function in children taking atrio-ventricular septal defect repair under cardiopulmonary bypass

Objective　To investigate the effect of cold crystal cardioplegic solution andsodium creatine phosphate on myocardial energy metabolism and cardiopulmonaryfunction in children taking atrio-ventricular septal defect repair undercardiopulmonary bypass. Methods　This was aprospective random control study. Forty-eight children with atrio-ventricularseptal defect surgically treated under cardiopulmonary bypass in FoshanHospital Affiliated to Southern Medical University were selected, and weredivided into an experimental group and a control group by the random numbertable method, with 24 cases in each group. There were 14 males and 10 femalesin the control group, and they were (7.2±3.4) years old and weighed (20.2±5.8)kg. There were 16 males and 8 females in the experimental group, and they were(7.0±3.4) years old pand, weighed (20.4±9.5) kg. The conventional cold crystalcardioplegic solution with high potassium was used in the control group, andthe cold crystal cardioplegic solution with sodium creatine phosphate in 10mmol/L concentration was used in the experimental group. The repair ofatrio-ventricular septal defect under cardiopulmonary bypass was performed inboth groups. The cardiopulmonary bypass times, aortic cross-clamp times,cardiopulmonary bypass time assisting times, incidences of automaticallyrestoring of heart beat, cases of administration of dopamine and adrenaline,and postoperative ventilator support times in both groups were observed andrecorded. The serum levels of creatine kinase isoenzyme (CK-MB) and cardiactroponin I (cTnI) were detected by the immuno-fluorescence method beforecardiopulmonary bypass (T0), 5 (T1) and 30 min (T2) after aortic clamp release,and 4 (T3) and 24 hours (T4) after cardiopulmonary bypass. The venous bloodsample was taken before and 1 day after the operation; the contents ofadenosine triphosphate (ATP), adenosine diphosphate (ADP), adenosinemonophosphate (AMP), and creatine phosphate (CP) were determined by highperformance liquid chromatography. t test, chi-square test, and one-way ANOVA were used for statistical analysis. Results　There were no statistical differences in thecardiopulmonary bypass time, aortic cross-clam time, cardiopulmonary bypassassisting time, and incidence of automatically restoring of heart beat betweenthe experimental group and the control group [(63.4±13.4) h vs. (67.1±19.8) h,(30.9±11.6) h vs. (32.1±14.5) h, (18.3±10.1) h vs. (22.3±9.3) h, and 100.0%(24/24) vs. 100.0% (24/24); all P>0.05].The postoperative ventilator support time in the experimental group was shorterthan that in the control group [(6.7±2.3) h vs. (7.9±1.4) h], with astatistical difference (t=2.18, P=0.03). The levels of CK-MB at T1, T2,T3, and T4 in the experimental group were significantly lower than those in thecontrol group [(22.4±5.3) U/L vs. (27.5±7.7) U/L, (68.5±11.9) U/L vs.(80.4±16.7) U/L, (81.4±21.2) U/L vs. (98.5±34.7) U/L, and (55.9±14.7) U/L vs.(67.3±17.6) U/L], with statistical differences (t=2.67, 2.84, 2.06, and 2.44; all P<0.05). The levels of cTnI at T1, T2, T3, and T4 in theexperimental group were significantly lower than those in the control group[(7.40±3.10) µg/L vs. (9.90±2.30) µg/L, (6.00±2.20) µg/L vs. (8.90±4.00) µg/L,(6.40±3.30) µg/L vs. (8.60±4.10) µg/L, and (6.80±2.60) µg/L vs. (8.90±3.40)µg/L], with statistical differences (t=3.17,3.11, 2.05, 2.40; all P<0.05). Thelevels of ATP, ADP, AMP, and CP at T4 in the experimental group weresignificantly higher than those in the control group, with statisticaldifferences (all P<0.05). Theoxygenation index at T4 in the experimental group was higher than that in thecontrol group [(331.6±43.3) vs. (273.7±33.3)], with a statistical difference (t=2.90, P<0.01). Conclusion　The cold crystalcardioplegic solution with high concentration of potassium containing sodiumcreatine phosphate can alleviate myocardial ischemia-reperfusion injury inchildren taking atrio-ventricular septal defect repair under cardiopulmonarybypass and maintain their heart energy supply during myocardial ischemia andthe lung oxygenation index after operation, has good cardiopulmonaryprotection, and is beneficial for their postoperative rehabilitation.