摘要
目的 研究风湿性心脏病心瓣膜替换术患者 ,术中应用不同浓度的左 卡尼汀作为心麻痹液的组成成分进行冠状动脉顺行灌注对心肌的保护作用。方法 6 9例风湿性心脏病体外循环(CPB)下心瓣膜替换术患者随机分为治疗Ⅰ组 (2 2例 )、治疗Ⅱ组 (2 4例 )和对照组 (2 3例 )。治疗Ⅰ组术中于St.ThomasⅡ号冷晶体心麻痹液中加入左 卡尼汀 12g/L ,治疗Ⅱ组为 6g/L ,对照组则应用St.ThomasⅡ号冷晶体心麻痹液 ,三组其他条件相同。结果 治疗组患者术毕和术后多巴胺、多巴酚丁胺 (二者用量比例为 1∶1)等血管活性药物用量明显少于对照组 (分别为 32 9mg± 5 4mg、339mg± 4 7mg、6 6 9mg± 5 6mg ,P <0 0 1) ,但两治疗组比较差异无显著意义 (P >0 0 5 )。血清心肌肌钙蛋白I(cTnI)、门冬氨基酸转移酶 (AST)、乳酸脱氢酶 (LDH)、肌酸激酶 (CK)、肌酸激酶MB同工酶 (CK MB)从转流结束到术后 3d明显低于对照组 (P <0 0 5或P <0 0 1)。其中治疗Ⅰ组cTnI明显低于治疗Ⅱ组术后 1d分别为 5 71μg/L± 1 14 μg/L、7 87μg/L± 1 89μg/L ,(P <0 0 5 ) ;术后 3d分别为 5 0 1μg/L± 0 89μg/L、7 5 3μg/L± 1 4 3μg/L ,(P <0 0 5 )。治疗组患者术毕心脏自动复跳率明显高于对照组 (分别为87 9%、74 3%、4 5 7% 。
Objective To investigate the myocardial protective effect of L-carnitine as an ingredient of cardiac arresting solution in the process of heart valve replacement operation. Methods 69 cases undergoing heart valve replacement with cardiopulmonary bypass (CPB), 47 males and 22 females, aged 48.17±14.22 (16～74 years), were divided into 3 groups: test group I (n=22, 12 g/L L-carnitine was put in the St.Thomas II cold crystal cardiac arresting liquid), test group II (n=24, 6 g/L L-carnitine was put in the St.Thomas II cold crystal cardiac arresting liquid), and control group (n=23, no L-carnitine was put in the St.Thomas II cold crystal cardiac arresting liquid). Before operation, 20 minutes after the beginning of shunt, after the finish of shunt, and 8 hours, one day, 3 days, and 7 days after operation venous blood was drawn to test the serum cardial tropnin I(cTnI), aspartate transaminase, lactate dehydrogenase, creatine kinase (CK) and CK-MB isozyme. Heart color ultrasonography was conducted to test the cardiac index (CI) and left heart ejecting fraction (EF) one day before operation and 7 days after operation. Before shunt and by the end of intracardiac procedure a bit of myocardial tissue was taken to undergo electron microscopy. The amounts of vaso-active drugs, such as dopamine and dobutamine, used postoperatively, and the postoperative cardiac auto-rebeating rate were recorded. Results The Amounts of vaso-active drugs used after operation was 329±54 mg in the test group I and 339±47 mg in the test group II, both significantly less than in the control group (669±56 mg, both P<0.01) without a significant difference between the 2 test groups. Since the end of CPB to 3 days after operation, the serum levels of cTnI, aspartate transaminase, lactate dehydrogenase, CK and CK-MB isozyme were significantly lower in the 2 test groups than in the control group (P<0.05 or P<0.01). The serum level of cTnI in test group I was significantly lower than in the test group II (5.71±1.14 ng/ml vs 7.87±1.89 ng/ml 1 day postoperatively (P<0.05), and 5.01±0.89 ng/ml vs 7.53±1.43 ng/ml 3 days postoperatively (P<0.05). The postoperative cardiac auto-rebeating rate was 87.9% in the test group I and 74.3% in the test group II, both significantly higher than that in the control group (45.7%, P<0.05 and P<0.01). Heart color ultrasonogram showed that 7 days postoperatively the CI index was 2.86±0.55 and 2.74±0.56 in the 2 test groups, significantly higher than that in the control group (2.11±0.35, both P<0.05), and the left heart EF were 64.3±8.6 and 59.1±6.7 in the 2 test groups, both significantly higher than that in the control group (51.7±4.9, both P<0.05). Electron microscopy showed only slight swelling of mitochondria in the cardial cell and the myocardial fiber was intact by the end of operation in the 2 test groups without significant difference between these 2 groups, however, in the control group swelling of mitochondria with vesicle formation, fissure of part of mitochondrial ridges, and disappearance of glycogen particles were found. Conclusion Antegrade coronary perfusion of L-carnitine has a good protective effect on myocardium and is worth spreading for heart valve replacement patients with cardiopulmonary bypass.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2003年第21期1887-1890,共4页
National Medical Journal of China
基金
贵州省优秀科技人才省长专项基金资助项目 ( 2 0 0 1年第 4号 )
关键词
左-卡尼汀
体外循环
心瓣膜替换术
心肌
保护作用
Heart valve replacement operation
Myocardial protection
Cardioplegia solution
L-carnitine
