注射用磷酸肌酸钠在冠状动脉搭桥术围手术期的心肌保护作用
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摘要
目的:探讨注射用磷酸肌酸钠应用在冠状动脉搭桥术(CABG)围手术期的心肌保护作用。方法:60例CABG治疗患者,随机分成观察组和对照组,每组30例。对照组患者术后采用常规药物治疗,而观察组则在对照组的基础上予以磷酸肌酸钠治疗。比较两组患者围手术期肌酸激酶同工酶(CK-MB)和心肌钙蛋白I(cTnI)水平的差异。结果:两组患者主动脉插管前(T0)和开放循环后30 min(T1)时CK-MB和cTnI数值比较差异无统计学意义(P>0.05),观察组患者体内CK-MB和cTnI水平在术后72 h(T2)明显低于对照组患者,差异有统计学意义(P<0.05)。结论:注射用磷酸肌酸钠在CABG围手术期应用可以有效的减少缺血再灌注损伤,发挥心肌保护作用。
Objective:To investigate the myocardial protective effect of Phosphocreatine in the coronary artery bypass graft surgery perioperative.Method:60 patients with CABG treated in the author's hospital were randomly divided into two groups,which were the observation group(n=30) and the control group(n=30).The patients of control group were treated by conventional drugs,and the patients of observation group were treated by Phosphocrentine combining with conventional drugs.The differences of creatine kinase isoenzyme(CK-MB) and cardiac troponin I(cTnI) levels were observed between the two groups.Result:There were no statistical differences of CK-MB and cTnI between the two groups in the time of the aortic intubation(T0) and the open cycle after 30 min(T1)(P>0.05).Compared with the control group,the level of CK-MB and cTnI at T2 in the observation group was significantly lower,the differences were statistically significant(P<0.05).Conclusion:Phosphocreatine can effectively reduce the ischemia reperfusion injury in the perioperative period of CABG application,which play a role in myocardial protection.
Objective:To investigate the myocardial protective effect of Phosphocreatine in the coronary artery bypass graft surgery perioperative.Method:60 patients with CABG treated in the author's hospital were randomly divided into two groups,which were the observation group(n=30) and the control group(n=30).The patients of control group were treated by conventional drugs,and the patients of observation group were treated by Phosphocrentine combining with conventional drugs.The differences of creatine kinase isoenzyme(CK-MB) and cardiac troponin I(cTnI) levels were observed between the two groups.Result:There were no statistical differences of CK-MB and cTnI between the two groups in the time of the aortic intubation(T0) and the open cycle after 30 min(T1)(P>0.05).Compared with the control group,the level of CK-MB and cTnI at T2 in the observation group was significantly lower,the differences were statistically significant(P<0.05).Conclusion:Phosphocreatine can effectively reduce the ischemia reperfusion injury in the perioperative period of CABG application,which play a role in myocardial protection.
引文
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[12]赵卫东,李金钟,刘亚军,等.磷酸肌酸钠对不停跳冠脉搭桥术患者心肌酶的影响[J].河北医药,2011,33(19):2956-2957.
[13]林岩峰,郑武扬,王庆祥,等.磷酸肌酸钠对老年脊柱手术患者的心肌酶学的影响[J].医学综述,2011,17(18):2880.
[14]苑晓烨,王素星,曾强,等.磷酸肌酸钠对严重肺部感染老老年患者心肌酶影响的研究[J].河北医药,2014,36(23):2612-2613.
[2]Salari A,Hasandokht T,Mahdavi-Roshan M,et al.Risk factor control,adherence to medication and follow up visit,five years after coronary artery bypassgraft surgery[J].J Cardiovasc Thorac Res,2016,8(4):152-157.
[3]叶明,吴辉.心肌缺血再灌注损伤的研究新进展[J].中华老年心脑血管病杂志,2016,18(4):434-437.
[4]朱江,潘海龙,陈洪,等.儿童先天性心脏病手术中磷酸肌酸的心肌保护作用[J].中华全科医学,2015,13(4):576-578.
[5]石佳,袁素,薛庆华,等.冠心病患者围术期应用磷酸肌酸的心肌保护作用研究[J].中国分子心脏病学杂志,2010,10(1):44-47.
[6]徐盟.心肌缺血再灌注损伤的主要机制与相关药物治疗的研究进展[J].实用药物与临床,2014,17(8):1052-1056.
[7]Bertinchant J P,Ledermann B,Schmutz L,et al.Diagnostic and prognostic significance of CK-MB,troponins,CRP,BNP and/or NTpro BNP in coronary angioplasty.Elevation mechanisms and clinical implications[J].Arch Mal Coeur Vaiss,2007,100(11):925-933.
[8]Bertinchant J P,Polge A,Juan J M,et al.Evaluation of cardiac troponin I and T levels as markers of myocardial damage in doxorubicin-induced cardiomyopathy rats,and their relationship with echocardiographic and histological findings[J].Clin Chim Acta,2003,329(1-2):39-51.
[9]Desrois M,Kober F,Lan C,et al.Effect of isoproterenol on myocardial perfusion,function,energy metabolism and nitric oxide pathway in the rat heart-a longitudinal MR study[J].NMR Biomed,2014,27(5):529-538.
[10]孙小芬,康芳,沈玉君,等.磷酸肌酸后处理对大鼠脑缺血-再灌注损伤的影响[J].临床麻醉学杂志,2016,32(3):268-272.
[11]Wallimann T,Dolder M,Schlattner U,et al.Some new aspects of creatine kinase(CK):compartmentation,structure,function and regulation for cellular and mitochondrial bioenergetics and physiology[J].Biofactors,1998,8(34):229-234.
[12]赵卫东,李金钟,刘亚军,等.磷酸肌酸钠对不停跳冠脉搭桥术患者心肌酶的影响[J].河北医药,2011,33(19):2956-2957.
[13]林岩峰,郑武扬,王庆祥,等.磷酸肌酸钠对老年脊柱手术患者的心肌酶学的影响[J].医学综述,2011,17(18):2880.
[14]苑晓烨,王素星,曾强,等.磷酸肌酸钠对严重肺部感染老老年患者心肌酶影响的研究[J].河北医药,2014,36(23):2612-2613.