腺苷预处理减轻非体外循环冠状动脉旁路移植术后患者心肌早期损伤的临床观察

目的 观察腺苷预处理对非体外循环冠状动脉旁路移植术（OPCAB）患者心肌损伤的影响。方法择期非体外循环冠状动脉旁路移植术患者40例,随机分为对照组和试验组,每组20例。试验组在取乳内动脉时经颈内静脉导管输注腺苷50μg·kg^-1·min^-1,1min后调至100μg·kg^-1·min^-1,2min后调至150μg·kg^-1·min^-1,输注10min。对照组给予生理盐水。输注结束后5min开始血管吻合。于麻醉后（哟）、血运重建30min（T1）、2h（T2）、6h（T3）、12h（T4）和24h（T5）取静脉血检测血浆肌酸激酶同功酶（CK-MB）和肌钙蛋白I（cTnI）浓度。结果 与基础值比较两组各时点CK-MB均升高,对照组T1-T5升高,差异有统计学意义（P〈0．05）,试验组仅他升高,差异有统计学意义（P〈0．05）。两组比较眄点试验组低于对照组,差异有统计学意义（P〈0．05）。与基础值比较两组各时点cTnI均升高,差异有统计学意义（P〈0．05）,两组比较T4-T5试验组低于对照组差异有统计学意义（P〈0．05）。结论非体外循环冠状动脉旁路移植术仍可发生心肌损伤,腺苷预处理能减少CK-MB和cTnI释放,减轻心肌损伤。

Adenosine preconditioning reduces myocardial injury in patients undergoing off-pump coronary artery bypass grafting surgery

OBJECTIVE: To evaluate the effects of adenosine on reducing myocardial injuries in patients undergoing off-pump coronary artery bypass grafting (OPCAB). METHODS: Forty patients undergoing OPCAB were allocated into two equal groups randomly: adenosine (ADO) group and control group. The patients in the ADO group were given infusion of adenosine through the central venous catheter via internal jugular vein when the surgeons dissociated the internal mammary artery. The initial infusion rate was 50 microg.kg(-1).min(-1), the infusion speed increased every minute until the dose of 150 microg.kg(-1).min(-1), and the total duration of adenosine infusion lasted for 10 min. The patients of the control group received intravenous infusion of 0.9% saline instead during the infusion period. 5 min after the completion of adenosine or saline infusion protocol, revascularization began. Blood samples were collected at following time points: T0 (10 minutes after anesthesia), T1, T2, T3, T4, and T5 (30 minutes, and 2, 6, 12, and 24 hours after revascularization respectively). Levels of MB isoenzyme of creatine kinase (CK-MB) and cardiac troponin I (cTnI) were measured. RESULTS: The CK-MB levels of the control group increased from T1 to T5 (all P < 0.05), and the CK-MB level of the ADO group increased only at T2 (P < 0.05), however, the level of CK-MB 24 h after revascularization of the control group was significantly higher than that of the ADO group (P < 0.05). The cTnI level increased significantly after revascularization (from T1 to T5) in both group (all P < 0.05), and the cTnI levels of the control group were higher than those of the ADO group at all time points, and were significantly higher at T4 and T5 points (both P < 0.05). CONCLUSION: OPCAB can cause myocardial injuries which can be reduced by adenosine preconditioning through the reduction of the release of CK-MB and cTnI.