CAJ | 학술논문

目的观察体外循环下经主动脉根部注射参麦注射液对二尖瓣置换术患者心肌损伤的影响.方法拟行二尖瓣置换术患者40例,将患者随机分为两组(n=20):对照组(C组)和参麦组(S组),每组20例.S组于阻断升主动脉后,立即经升主动脉根部注射参麦注射液1 ml/kg,随后灌注4℃高钾(K+浓度:22 mmol/L)含血心脏停搏液20 ml/kg;C组注射等量生理盐水,随后灌注4℃高钾(K+浓度:22 mmol/L)含血心脏停搏液20 ml/kg,两组患者每30 min复灌不含参麦的相同成分含血心脏停搏液10 ml/kg.分别于主动脉阻断前即刻(T1)、主动脉阻断后4h(T2)和术后24 h(T3)时,采集中心静脉血4ml,测定血浆心肌肌钙蛋白Ⅰ(cTnI)浓度、肌酸激酶(CK)和肌酸激酶同功酶(CK-MB)的活性.记录阻断升主动脉至心脏停搏所用时间、心脏自动复跳率、心脏复跳期间利多卡因使用剂量及体外循环(CPB)后1h多巴胺用量.结果 T2～T3时C组血浆cTnI浓度分别为(7.29±1.86)、(5.46±1.59) μg/L,S组T2～ T3时血浆cTnI浓度值分别为(4.81±1.50)、(2.62±0.78)μg/L,两组比较S组T2～T3时血浆cTnI浓度值降低(P ＜0.05);T2～T3时C组血浆CK浓度值分别为(99±11)和(70±9)U/L,S组T2～T3时血浆CK浓度值分别为:(59±9)、(32±5) U/L,T2～ T3 S组时血浆CK浓度值降低(P ＜0.05);T2～T3时C组血浆CK-MB浓度值分别为(8.8±1.9)、(5.5±1.6) U/L,S组T2～时血浆CK-MB浓度值分别为(5.3±1.2)、(3.7±0.9)U/L,T2～T3S组时血浆CK-MB浓度值降低(P＜0.05).结论体外循环下经主动脉根部注射参麦注射液可减轻二尖瓣置换术患者心肌的损伤.
목적 관찰체외순배하경주동맥근부주사삼맥주사액대이첨판치환술환자심기손상적영향.방법 의행이첨판치환술환자40례,장환자수궤분위량조(n=20):대조조(C조)화삼맥조(S조),매조20례.S조우조단승주동맥후,립즉경승주동맥근부주사삼맥주사액1 ml/kg,수후관주4℃고갑(K+농도:22 mmol/L)함혈심장정박액20 ml/kg;C조주사등량생리염수,수후관주4℃고갑(K+농도:22 mmol/L)함혈심장정박액20 ml/kg,량조환자매30 min복관불함삼맥적상동성분함혈심장정박액10 ml/kg.분별우주동맥조단전즉각(T1)、주동맥조단후4h(T2)화술후24 h(T3)시,채집중심정맥혈4ml,측정혈장심기기개단백Ⅰ(cTnI)농도、기산격매(CK)화기산격매동공매(CK-MB)적활성.기록조단승주동맥지심장정박소용시간、심장자동복도솔、심장복도기간리다잡인사용제량급체외순배(CPB)후1h다파알용량.결과 T2～T3시C조혈장cTnI농도분별위(7.29±1.86)、(5.46±1.59) μg/L,S조T2～ T3시혈장cTnI농도치분별위(4.81±1.50)、(2.62±0.78)μg/L,량조비교S조T2～T3시혈장cTnI농도치강저(P ＜0.05);T2～T3시C조혈장CK농도치분별위(99±11)화(70±9)U/L,S조T2～T3시혈장CK농도치분별위:(59±9)、(32±5) U/L,T2～ T3 S조시혈장CK농도치강저(P ＜0.05);T2～T3시C조혈장CK-MB농도치분별위(8.8±1.9)、(5.5±1.6) U/L,S조T2～시혈장CK-MB농도치분별위(5.3±1.2)、(3.7±0.9)U/L,T2～T3S조시혈장CK-MB농도치강저(P＜0.05).결론 체외순배하경주동맥근부주사삼맥주사액가감경이첨판치환술환자심기적손상.
Objective To investigate the effects of Shenmai injection through aortic root on myocardial injury in patients undergoing mitral valve replacement (MVR).Methods Forty consenting ASA Ⅱ or Ⅲ patients undergoing elective MVR were randomly divided into 2 groups (n =20 each):Shenmai injection group (S) and control group (C).In S group myocardial arrest was produced by infusing Shenmai injection (1 ml/kg) through aortic root after aorta was cross-clamped,followed by cold blood cardiaplegic solution (20 ml/kg).In C group asystole was produced with cold blood cardioplegic solution (20 ml/kg) alone every 30 min.Blood samples (4 ml) were taken from the central vein at 5 min before (T1) and 4 h after aortic cross-clamping (T2) and 24 h after operation (T3) for determination of plasma cardiac troponin I (cTnI) concentration and the concinase (CK) and creatin kinase isoenzyme-MB (CK-MB).The restoration of spontantaneous heart,the amount of dopamine administered during the 2 h after cardiopulmonary bypass (CPB) and aortic cross-clamping time were recorded.Results The concenentration of serum cTnI at T2-T3was (7.29±1.86) and (5.46±1.59) μg/L in C group,and (4.81 ±1.50) and (2.62±0.78) μg/L in S (P ＜ 0.05).The concenentration of serum CK at T2-T3 was (99 ± 11) and (70 ± 9) U/L in C group,and (59 ± 9) and (32 ± 5) U/L in S group (P ＜ 0.05).The concenentration of serum CK-MB at T2-T3 was (8.8±1.9) and (5.5±1.6) U/Lin C group,and (5.3 ±1.2) and (3.7±0.9) U/L in S group (P＜0.05).Conclusion Shenmai injection through aortic root can attenuate the myocardial injury in patients undergoing MVR.