L-精氨酸在体外循环中心肌保护的临床应用

目的 评价L-精氨酸加入心脏停搏液中对体外循环心脏直视手术期间心肌保护作用的效果。方法 30例择期心脏手术患者随机分为两组。实验组（L组）：芷心脏晶体停搏液中加入L-精氨酸4．0g／L，对照组（C组）：在心脏晶体停搏液中加入等量的生理盐水。在转流前、开放主动脉后30min、术后6h、24h、48h，采血检测血清中心肌肌钙蛋白Ⅰ（cTnI）的浓度，并记录临床观察指标。结果 开放后辅助循环时间、开放主动脉后心脏自动复跳率、术后24h心血管活性药物的应用两组间有明显差异（P〈0．05）。两组血清cTnI浓度在转流前无差异，开放主动脉后各时点cTnI浓度实验组均低于对照组（P〈0．05）。结论 在心脏停搏液中加入L-精氨酸，可有效地保护缺血心肌，减轻心肌再灌注损伤。

The Clinical Use of the L-Arginine to Protect Myocardium in Cardiopulmonary Bypass

OBJECTIVE To investigate the myocardial protective effect of L-arginine added into cardioplegic solution used in CPB.METHODS Thirty patients scheduled to undergo cardiac operations with CPB were divided randomly into two groups:the experimental group (group L,n=15)received L-arginine 4.0g/L in cardioplegic solution;the control group(group C,n=15)received saline solution in the same fashion.The methods of CPB and infusion in two groups were the same. Blood samples were taken before CPB,after aortic declamping 30min,6 ,24,48 hours after operation respectively.Then the level of cTnI in blood plasma was tested by chemiluminescent immunoassay system.Clinical parameters were observed and compared .RESULTS The supplementary time of group C was significant longer than that of group L(P<0.05).The ratio of myocardial auto-resuscitation in group L was significant higher than that in group C(P<0.05).The doses of positive inotropic medicine of postoperative in group L was much lower than those in group C(P<0.05).The plasma level of cTnI in two groups was similar before CPB,but at each point after aortic declamping the plasma level of cTnI in group L was obviously lower than that in group C(P<0.05).CONCLUSION The results suggest that L-arginine added to the cardioplegic solution offers better myocardium protective effect in CPB.