改良心肌保护液在婴幼儿心内直视手术中的应用*★

摘要

BACKGROUND:The research at home and abroad for appropriate immature myocardial cardioplegia has no breakthrough, and it may be a better mean to improve the protection effect of existing cardioplegia on immature myocardial by adding ingredients. Adenosine can reduce ischemia and neutrophil-mediated reperfusion injury, and salvia miltiorrhiza can reduce the content of ischemic myocardial lipid peroxide and increase the scavenging of myocardial cells to oxygen radical. OBJECTIVE:To investigate the protection effect of improved myocardial protection fluid containing adenosine and salvia miltiorrhiza on the heart, liver and kidney. METHODS:Sixty cases of infant open heart operation of the first time were randomly divided into three groups, 20 cases in each group. The adenosine group received the improved myocardial protection fluid added with adenosine, the combination group received the improved myocardial protection fluid added with adenosine and miltiorrhiza salvia, and the control group received the improved myocardial protection fluid in the same volume. The blood samples were taken at the time before anesthesia induction, 30 minutes after cardio pulmonary bypass beginning, 1 hour after cardio pulmonary bypass end and 24 hours after cardio pulmonary bypass end. The serum levels of the creatine kinase, alanine aminotransferase, aspartate aminotransferase, blood urea nitrogen, creatinine, tumor necrosis factor-α, interleukin-6, interleukin-8 and interleukin 10 were detected. RESULTS AND CONCLUSION:The serum levels of the alanine aminotransferase, aspartate aminotransferase, blood urea nitrogen, creatinine and creatine kinase in three groups were increased, but the control group was increased significantly (P<0.01), and there were significant differences between adenosine group and combination group (P<0.05);the levels of tumor necrosis factor-α, interleukin-6 and interleukin-8 were significantly increased after operation (P<0.05). The levels of tumor necrosis factor-α, interleukin-6 and interleukin-8 in the control group were significantly higher than those in the adenosine group and combination group before induction and at the same time point (P<0.01);at 3 minutes and 24 hours after cardio pulmonary bypass, the level of interleukin-10 was increased in three groups, but the level of interleukin-10 in the adenosine group was significantly higher than that in the control group (P<0.01). The results indicate that improved myocardial protection fluid has great protection effect on immature myocardial, and can significantly reduce the serum levels of tumor necrosis factor-α, interleukin-6 and interleukin-8, promote the secretion of interleukin-10 that can inhibit inflammatory cytokine and can significantly reduce the inflammatory response caused by cardiopulmonary bypass. So the improved myocardial protection fluid has protection effect on important organs, such as heart, lung, liver and kidney.%　　背景：目前国内外对于适合未成熟心肌停搏液的研究均未取得突破性进展，通过添加成分来提高现有停搏液对未成熟心肌的保护可能是一个较好的手段。腺苷能减轻缺血和中性粒细胞介导的再灌注损伤；丹参能降低缺血心肌脂质过氧化物含量，增加心肌细胞对氧自由基的清除。目的：探讨添加腺苷和丹参的改良心肌保护液对心脏、肝脏、肾脏的保护作用。方法：60例首次心内直视手术婴幼儿随机分为3组，各20例，腺苷组采用改良心肌保护液添加腺苷，联合组采用改良心肌保护液添加腺苷和丹参，对照组采用等容量的改良心肌保护液。于麻醉诱导前、体外循环开始后30 min、体外循环结束后30 min及体外循环结束后24 h采集患儿血标本，检测血清肌酸激酶同工酶、谷丙转氨酶、谷草转氨酶、尿素氮、肌酐、肿瘤坏死因子α、白细胞介素6、白细胞介素8、白细胞介素10水平变化。结果与结论：3组患儿血清谷丙转氨酶、谷草转氨酶、尿素氮、肌酐、肌酸激酶同工酶均有升高，但是对照组升高最明显(P<0.01)，腺苷组和联合组比较差异有显著性意义(P<0.05)；肿瘤坏死因子α、白细胞介素6，白细胞介素8水平均比术前显著升高(P<0.05)。对照组肿瘤坏死因子α、白细胞介素6、白细胞介素8明显高于诱导前以及相同时点腺苷组和联合组的水平(P <0.01)；体外循环结束后30 min及24 h，3组白细胞介素10水平均明显增高，但腺苷组和联合组明显高于对照组(P <0.01)。提示改良心肌保护液对未成熟心肌有良好的保护作用，能明显降低心内直视手术患儿血浆肿瘤坏死因子α、白细胞介素6、白细胞介素8水平，促进抑制炎细胞因子白细胞介素10的分泌，有效降低由体外循环引发的炎症反应，对心、肺、肝、肾等重要脏器有保护作用。