复合辅酶对冠心病患者围术期心肌保护和肝脏保护作用的研究

目的:探讨冠心病(CAD)患者体外循环(CPB)冠状动脉旁路移植(CABG)术中使用复合辅酶对心肌和肝脏保护的效果。方法:70例择期CPB下进行CABG的CAD患者,随机分为试验组与对照组各35例,试验组术中给予辅酶A1000u和辅酶I1.0mg,对照组不给复合辅酶。观察CPB时间、主动脉阻断时间、正性肌力药使用情况、ICU停留时间、术后住院时间、围术期心肌梗死和脑卒中等临床指标。2组分别于手术开始前、手术结束时、手术后6h、12h、24h和术后3d采集患者中心静脉血,检测红细胞压积、肌酸激酶、肌酸激酶同工酶和肌钙蛋白I;于手术开始前、手术结束时、手术后3d和手术后7d采血检测谷丙转氨酶、谷草转氨酶、总胆红素和直接胆红素。结果:2组术后心肌酶谱均较术前升高(P0.01),但在术后6h、12h和24h试验组心肌酶谱显著低于对照组(P0.01)。2组术后转氨酶和胆红素水平均较术前升高(P0.01),但在术后3d试验组的转氨酶和胆红素水平显著低于对照组(P0.01)。结论:CAD患者围术期应用复合辅酶具有一定的心肌保护和肝脏保护作用。

Myocardial and hepatic protection of compound coenzymes in patients undergoing on-pump coronary artery bypass grafting sugery

Objective：To evaluate the effects of cardioprotection and hepatoprotection of compound coenzymes in patients undergoing on-pump coronary artery bypass grafting（CABG）.Methods：A total of 70 consecutive coronary artery disease patients who were performed elective CABG procedure were randomly assigned to two groups：compound coenzymes group（n = 35） and control group（n = 35）.The patients in trial group was administered coenzymes A 1 000 U and coenzymes I 1.0 mg via the central venous catheter before CABG.CPB duration,aortic cross clamping time,length of ICU stay,postoperative hospital stay,perioperative myocardial infarction,stroke and in-hospital motality were recorded.Blood samples were collected at 6 time points（pre-operation,the end of operation,postoperative 6 hours,12 hours,24 hours and 3 days） to measure the plasma concentration of creatine kinase,creatine kinase-MB and troponin I.Alanine aminotransferase,aspartate aminotransferase,serum total bilirubin and direct bilirubin were measured preoperatively,immediate after surgery,postoperative 3 days and 7 days.Results：The level of postoperative myocardial enzymes was significantly higher comparing with baseline values（P 0.01）,whereas they were significantly lower in compound coenzymes group than in control group（P 0.01）.The levels of postoperative aminotransferases and bilirubin were also significantly higher comparing with baseline values（P 0.01）,and they were significantly lower in compound coenzymes group than in control group（P 0.01）.Conclusion：Compound coenzymes revealed significant cardioprotection and hepatoprotection effects in patients undergoing on-pump CABG.