摘要
目的探讨磷酸肌酸钠(CP)联合处理对腔镜下心内直视手术患者的心肌缺血再灌注(I/R)损伤的影响。方法选择2022年1月至2023年4月在佛山市第二人民医院和暨南大学附属华侨医院就诊并计划在体外循环下行腔镜二尖瓣置换术或整形术的患者36例,采用随机数字表法,将患者分为预处理组、后处理组和联合处理组,每组12例。预处理组男8例,女4例;年龄(58.33±12.35)岁;心功能分级:Ⅲ级8例,Ⅳ级4例。后处理组男5例,女7例;年龄(59.67±13.77)岁;心功能分级:Ⅲ级7例,Ⅳ级5例。联合处理组男7例,女5例;年龄(59.92±11.29)岁;心功能分级:Ⅲ级9例,Ⅳ级3例。患者在全身麻醉和体外循环下行腔镜二尖瓣整形术或置换术。预处理组:体外循环开始前静脉注射CP 2.0 g,停搏液中加入CP 2.0 g;后处理组:主动脉开放后5 min体外循环机内注入CP 2.0 g,体外循环停止前体外循环机内注入CP 2.0 g;联合处理组:体外循环开始前静脉注射CP 1.0 g,停搏液中加入CP 1.0 g,主动脉开放后5 min体外循环机内注入CP 1.0 g,体外循环停止前体外循环机内注入CP 1.0 g。比较3组患者体外循环时间、主动脉阻断时间、体外循环辅助时间、心脏自动复跳情况以及术后多巴胺和肾上腺素的使用情况;比较3组患者术前、术毕、术后1 d和术后2 d的血肌酸激酶同工酶(CK-MB)、心肌肌钙蛋白I(cTnI)以及脑利钠肽(BNP)水平。采用F检验、LSD检验、χ^(2)检验、Fisher确切概率法、秩和检验。结果联合处理组术后48 h肾上腺素的使用比例(1/12)少于预处理组(6/12)和后处理组(5/12),差异有统计学意义(P<0.05)。联合处理组术毕的CK-MB水平[(12.14±4.98)U/L]低于预处理组[(17.51±5.14)U/L],差异有统计学意义(P<0.05);联合处理组术后1 d、术后2 d的CK-MB水平[(27.17±11.25)U/L、(17.10±8.27)U/L]均低于预处理组[(37.58±11.15)U/L、(26.46±8.98)U/L]和后处理组[(39.54±14.27)U/L、(24.28±7.07)U/L],差异均
Objective To observe the effect of combined treatment of creatine phosphate sodium(CP)on myocardial ischemia and reperfusion injury in patients undergoing endoscopic heart surgery.Methods A total of 36 patients who planned to undergo endoscopic heart surgery under cardiopulmonary bypass in the Second People's Hospital of Foshan and Affiliated Overseas Chinese Hospital of Jinan University from January 2022 to April 2023 were divided into a pre-treatment group,a post-treatment group,and a combined treatment group by the random number table method,with 12 case in each group.In the pre-treatment group,there were 8 males and 4 females,aged(58.33±12.35)years,cardiac function classification:grade III in 8 cases and grade IV in 4 cases.In the post-treatment group,there were 5 males and 7 females,aged(59.67±13.77)years,cardiac function classification:grade III in 7 cases and grade IV in 5 cases.In the combined treatment group,there were 7 males and 5 females,aged(59.92±11.29)years,cardiac function classification:grade III in 9 cases and grade IV in 3 cases.The patients underwent endoscopic mitral valve anaplasty or replacement under general anesthesia and cardiopulmonary bypass.In the pre-treatment group,2.0 g of CP was injected intravenously before cardiopulmonary bypass,and 2.0 g of CP was added into the cardiopulmonary bypass solution.In the post-treatment group,2.0 g of CP was injected into the cardiopulmonary bypass machine 5 min after aortic cross clamp release,and 2.0 g of CP was injected into the cardiopulmonary bypass machine before cease of cardiopulmonary bypass.In the combined treatment group,1.0 g of CP was injected intravenously before cardiopulmonary bypass,1.0 g of CP was added into the cardiopulmonary bypass solution,1.0 g of CP was injected into the cardiopulmonary bypass machine 5 min after aortic cross clamp release,and 1.0 g of CP was injected into the cardiopulmonary bypass machine before cease of cardiopulmonary bypass.The time of cardiopulmonary bypass,time of aortic cross clamp,time of cardiopu
作者
吴丽灵
张武
李贻霞
杨凯
梁结连
杜楚川
文先杰
胡旭东
钟执文
Wu Liling;Zhang Wu;Li Yixia;Yang Kai;Liang Jielian;Du Chuchuan;Wen Xianjie;Hu Xudong;Zhong Zhiwen(Operating Room,The Second People's Hospital of Foshan,Foshan 528099,China;Department of Cardiac Surgery,The Second People's Hospital of Foshan,Foshan 528099,China;Department of Anesthesiology,The Second People's Hospital of Foshan,Foshan 528099,China;Department of Cardiac Surgery,Affiliated Overseas Chinese Hospital of Jinan University,Guangzhou 510627,China)
出处
《国际医药卫生导报》
2024年第10期1652-1658,共7页
International Medicine and Health Guidance News
基金
2022年度佛山市医学科研课题(20220362)。
关键词
心肌缺血再灌注损伤
磷酸肌酸钠
预处理
后处理
联合处理
腔镜心脏手术
Myocardial ischemia and reperfusion injury
Creatine phosphate sodium
Pre-treatment
Post-treatment
Combined treatment
Endoscopic heart surgery
