磷酸肌酸钠在婴幼儿心内直视手术中的心肌保护作用

摘要

Objective: To investigate the myocardial protective effects of creatine phosphate(CP) in infants undergoing open heart surgery and clinical practical values. Methods: Forty infant patients with ASD(atrial septal defect)or VSD(ventricular septal defect)were randomly divided into CP and hypothermal crystal hyperkalium cardioplegic solution group. Creatine kinase-isoenzymes(CK-MB),cardiac troponin I(cTnI)and clinical items(cardiopulmonary bypass,CPB time,aortic off-clamping time,mechanical ventilation time,dopamine dosage immediately after operation and 12 h after operation)were measured in each group before CPB,at 10 min after the aorta off-clamping,after CPB and at 2,]2 h after operation respectively. Results:Clinical items of CP group were better than that of control group (P < 0. 05 ). The level of CK-MB and cTnl rise after aortic off-clamping, and reached the peak after CPB. There were statistic differences between pre-CPB and after CPB in each group (P<0.01). CK-MB and cTnI level of CP group were lower than that of control group. There were statistic differences between two groups (P < 0. 05 ) . Conclusion: CP cardioplegic solution can enhance infants myocardial protection,which undergoing open heart surgery.%目的:探讨磷酸肌酸钠(CP)在婴幼儿心内直视术中的心肌保护作用及其临床应用价值.方法:选择40例房间隔缺损(ASD),或室间隔缺损(VSD)的先天性心脏病患儿,随机分为CP停搏液组和冷晶体高钾停搏液组.2组患儿均于体外循环(CPB)前、主动脉阻断10 min、转流结束后,术后2h和术后12 h,抽取中心静脉血2 mL,测肌酸激酶-同工酶(CK-MB)和肌钙蛋白Ⅰ(cTnl)的浓度;分别记录临床观察指标(体外循环时间、主动脉阻断时间、术后呼吸机辅助时间、手术结束后及术后12 h多巴胺用量).结果:CP组临床观察指标优于对照组(P＜0 05);2组CK-MB和cTnI浓度均于主动脉阻断后开始上升,于转流结束后达高峰,与CPB前比较差异有统计学意义(P＜0 01).2组间比较,实验组主动脉阻断后各时点升高的幅度低于对照组,差异有统计学意义(P＜0 05).结论:婴幼儿心内直视术中,应用含CP的停搏液对婴幼儿心肌具有良好的保护作用.