注射用复合辅酶对体外循环心肌保护作用

注射用复合辅酶对体外循环心肌保护作用 [摘要] 目的 探讨复合辅酶加预充液及心肌保护液对心脏瓣膜置换术中心肌损伤的保护作用及其机制。 方法 30例心脏瓣膜病患者随机分成实验组和对照组各15例。对照组不给药,实验组在麻醉诱导后预充液及心肌保护液中加入复合辅酶,主动脉阻断前后不同时点采桡动脉血测定围术期肌钙蛋白—,IcTnI,、肌酸激酶同工酶,CK—MB,、丙二醛,MDA,、红细胞压积,HCT,,停体外循环后15 min采右心房心肌组织,电镜下观察超微结构变化。 结果 主动脉开放后cTnI、CK—MB、MDA值显著升高,实验组显著低于对照组,超微结构示实验组心肌损伤明显轻于对照组。 结论 预充液及心肌保护液中应用复合辅酶可减轻体外循环瓣膜置换术心肌损伤。 [关键词] 复合辅酶,心肌保护,心肌缺血再灌注损伤,体外循环 [中图分类号] R654.1 [文献标识码] B [文章编号] 1673—9701,2012,26—0074—03 The protective effect of coenzyme complex on myocardium undergoing cardiopulmonary bypass operation 1 LIU Yong ZHAO Qifeng Department of Cardiothoracic Surgery,the Second Affiliated Hospital of Wenzhou Medical College,Wenzhou 325027,China [Abstract] Objective To investigate the protective effect of Coenzyme Complex on ischemic reperfusion,I/R, induced myocardial injury and its possible mechanism in heart valve replacement surgery. Methods Thirty patients with heart valve replacement surgery were randomly divided two groups. A treatment group,n = 15, received Coenzyme Complex in cardioplegia solution and and in the primary solution before anesthesia, and control group,n = 15, did not received Coenzyme Complex. Blood samples were taken from radial artery the blood to determine the serum concentrations of cTnI, CK—MB, MDA and HCT at various time points during cardiopulmonary bypass,CPB,. Right atrium myocardial biopsy,about 2 mm3,was performed 15 mintues after aortic unclamping for ultrastructure examination with electron microscope. Results After aortic unclamping, the values of cTnI, CK—MB, and MDA in treatment group were significantly lower than those of control group at 2 different time points,P 0.05,。见1。根据病情给予强心、利尿、扩血管等治疗。 表1 两组患者一般资料,n = 15, 注,MVR,二尖瓣置换术,AVR,主动脉瓣置换术,BVR,双瓣置换术 1.2 手术方法 实验组在麻醉诱导后CPB预充液中加入复合辅酶注射液,贝科能,北京双鹭药业股份有限公司,国药准字H11020001,0.01 mg/kg,停搏液中加入复合辅酶0.1 mg,对照组不给药。预充液用复方林格氏液,并根据术前HCT加入适量红细胞、冰冻血浆或20%人体白蛋白及10 mg/kg的甲基强的松龙,心肌保护采用4,1冷氧合血间断灌注。麻醉及体外循环方法,两组均为静吸复合麻醉。全身肝素化,肝素400 U/kg,。使用进口膜式氧合器,中度血液稀释,红细胞压积0.20,0.30,,浅低温30?,转流中激活全血凝固时间>480 s。升主动脉及上、下腔静脉插管或右心房插管,建立体外循环,转流降温,主动脉阻断后经主动脉根部切开直接灌注诱导停搏,首次含血停搏液灌注量为20 mL/kg,心脏表面置冰屑行心肌保护,以后每30 min灌注一次。经右心房、房间隔置换二尖瓣机械瓣,缝合房间隔切口,或经主动脉根部切口置换主动脉瓣机械瓣,缝合主动脉切口。转流复温,主动脉开放,左心排气后行循环,复温至肛温36?, 3 适当超滤,循环稳定后脱离心肺机。 4