摘要
目的探讨重症心脏瓣膜外科手术中含血停搏液内添加注射用心肌肽的心肌保护作用。方法对2016年1月至12月93例术前左心室射血分数(LVEF)小于50%的瓣膜外科手术进行回顾性分析,根据是否使用心肌肽分为心肌肽组(47例)和对照组(46例)。主要瓣膜外科手术有主动脉瓣置换37例、主动脉瓣置换+二尖瓣置换/成形12例、主动脉瓣置换+二尖瓣置换/成形+三尖瓣成形44例。心肌肽组仅在第一次含血停搏液中一次性添加心肌肽3 mg/kg,对照组在含血停搏液中不添加心肌肽。从围术期LVEF变化、心肌酶谱[肌酸激酶(CK)、肌酸激酶同工酶(CKMB)、乳酸脱氢酶(LDH)]变化、肝肾功能、ICU时间、血管活性药物使用等方面评价心肌肽的心肌保护作用。结果心肌肽组与对照组在患者年龄、体重、体外循环时间和主动脉阻断时间、ICU时间等均无显著性差异(P>0.05);心肌肽组患者术后24 h、48 h超声评价显示LVEF恢复程度均显著优于对照组(P<0.05),心功酶谱结果示术后48 h心肌肽组的CK和LDH恢复程度显著优于对照组(P<0.05),术后24 h CKMB恢复程度心肌肽组显著优于对照组(P<0.05)。两组患者肝肾功能指标无显著性差异(P>0.05)。入ICU时血管活性药物指数比较,心肌肽组显著低于对照组(P<0.05)。两组患者均无死亡。结论含血停搏液中添加心肌肽在重症瓣膜外科手术中具有一定的心肌保护作用。
Objective To investigate the myocardial protection effect of cardiomyopeptide in cardioplegia in severe valvular surgery. Methods From January to December of 2016,93 patients with low left ventricle ejection fraction（ LVEF〈 50%） underwent valvular surgery. Their clinical data were analyzed retrospectively. According to whether cardiomyopeptide was used,they were divided into cardiomyopeptide group（ 47 cases） and control group（ 46 cases）. Surgical procedures included 37 cases of aortic valve replacement,12 cases of aortic valve replacement and mitral valve replacement or mitral valvuloplasty,44 cases of aortic valve replacement and mitral valve replacement or mitral valvuloplasty and tricuspid valvuloplasty. Cardiomyopeptide was added only once in the first blood cardioplegia in cardiomyopeptide group,the dosage was 3 mg/kg. There was no cardiomyopeptide added into blood cardioplegia in control group. Perioperative LVEF,myocardial enzymes（ creatine kinase（ CK）,creatine kinase isoenzyme（ CKMB）,lactate dehydrogenase（ LDH））,liver and kidney function,ICU time and usage of vasoactive drugs were analyzed. Results There were no significant differences between the two groups in age,weight,cardioplumonary bypass time,aortic cross clamping time and ICU time（ P〉0.05）. Echocardiography at 24 h and 48 h after operation showed that LVEF increased dramatically in cardiomyopeptide group,but not in control group（ P 〈 0. 05）. Results of myocardium enzymogram showed that CK and LDH in cardiomyopeptide group at 48 h after operation were dramatically lower than those of the control group（ P 〈0.05）. CKMB in the cardiomyopeptide group was dramatically lower than that of the control group at 24 h after operation（ P 〈 0.05）. There were no significant differences in liver and kidney function between the two groups（ P 〉0.05）. The vasoactive drug index was dramatically lower in cardiomyopeptide group than that of the control group at initial ICU time（ P 〈 0. 05）. There was no mortality in both groups. Conclusion Application of cardiomyopeptide for injection in blood cardioplegia has myocardial protection effect in severe valvular surgery.
作者
张力
周成斌
李冠华
彭东
罗智超
林中林
章晓华
Zhang Li;Zhou Chengbin;Li Guanhua;Peng Dong;Luo Zhichao;Lin Zhonglin;Zhang Xiaohua(Department of Cardiac Surgery,Guangdong Cardiovascular Institute,Guangdong Provincial Key Laboratory of South China Structurel Heart Disease,Guangdong General Hospital,Guangdong Academy of Medical Sciences,Guangzhou 510080,China)
出处
《中国体外循环杂志》
2018年第4期196-199,共4页
Chinese Journal of Extracorporeal Circulation
基金
广东省医学科学技术研究基金项目(A2017410)
广东省省级科技计划项目(2017A070701013,2017B090904034,2017B030314109)
国家卫生计生委医药卫生科技发展研究中心课题(2016X-02-004)
关键词
心肌肽
心肌保护
重症瓣膜病
瓣膜外科手术
Cardiomyopeptide
Myocardial protection
Severe valvular disease
Valvular surgery
