抑肽酶对减轻非体外循环冠状动脉旁路移植术心肌损伤的影响

目的　观察抑肽酶对非体外循环冠状动脉旁路移植术心肌损伤的影响。方法　将 2 4例非体外循环冠状动脉旁路移植术患者随机分为两组 :抑肽酶组 (12例 )和对照组 (12例 )。抑肽酶组给予抑肽酶 2× 10 6 KIU在诱导后 30min内静脉输注 ,然后 0 5× 10 6 KIU h静脉输注维持至术毕。测量麻醉诱导后、冠状动脉血管吻合后 1h、术后 6h以及术后 2 4h各时间点肺动脉血中心肌损伤指标肌酸激酶同工酶 (CK MB)和肌钙蛋白Ⅰ (cTnI) ;记录术中自体血液回收量和术后即刻、术后 6h内和术后 2 4h内伤口引流量。结果　CK MB和cTnI在两组内于吻合后均明显升高 ,抑肽酶组心肌损伤指标cTnI在术后 6h和 2 4h均低于对照组 (P <0 0 5 ) ;抑肽酶组术后纵隔胸腔引流量在术后 6h内和 2 4h内均明显低于对照组 (P <0 0 5 )。结论　抑肽酶可以减轻非体外循环冠状动脉旁路移植术导致心肌损伤。

Aprotinin reduces myocardial injury in the off-pump coronary artery bypass grafting

OBJECTIVE: To investigate the effect of aprotinin on the myocardial injury during the off-pump coronary artery bypass grafting (OPCAB). METHODS: Twenty-four patients undergoing OPCAB randomly were of 12 patients divided into two groups: aprotinin group and Control group (n = 12). In the aprotinin group a loading dose (2 x 10(6) KIU) was administered within the first 30 minutes after the induction followed by continuous infusion of 0.5 x 10(6) KIU/h throughout the operation. The plasma myocardial injury markers CK-MB and cTnI were measured at the four points: (1) After induction; (2) 1 hour after coronary anastomosis; (3) 6 hours and (4) 24 hours after the operation. The blood loss was recorded by autotransfusion in the operation, and the drainage immediately, 6 hours, and 24 hours after the operation. RESULT: Myocardial injury markers CK-MB and cTnI increased significantly after the anastomosis in each group; cTnI was lower in the aprotinin group than in the control group at the third and forth points (P < 0.05). The post-operative drainage after 6 hours and 24 hours were lower in the aprotinin group than in control group (P < 0.05). CONCLUSIONS: There is the myocardial injury during OPCAB. Aprotinin can reduce the myocardial injury during OPCAB.