川芎嗪预处理对风心瓣膜病患者围术期肌钙蛋白I变化的影响及其临床意义
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摘要
目的：通过川芎嗪预处理对风心瓣膜病患者围术期血浆中肌钙蛋白Ⅰ变化影响的研究，探讨川芎嗪预处理对风心瓣膜病患者心脏直视手术心肌细胞的保护作用。方法：随机选取2003年7月至2004年4月安徽医科大学第一附属医院心血管外科手术治疗风心瓣膜病40例。随机分为川芎嗪预处理组(A组，n=20)及对照组(B组，n=20)。川芎嗪预处理组手术前1周开始应用盐酸川芎嗪注射液4mg／kg／d(常州制药厂，40mg／支，生产批号0204002)至术前一天，两组分别于用药前、主动脉阻断后30分钟、主动脉开放后30分钟、术后24h、术后48h，术后72h和术后150h抽取静脉血，根据需要行抗凝、离心，分离出血浆，测定血浆中心肌肌钙蛋白Ⅰ(cTnI)、磷酸肌酸激酶(CK)、磷酸肌酸激酶同工酶(CK-MB)、乳酸脱氢酶(LDH)。记录心脏自动复跳率和术后正性肌力药物使用、并发症及愈后情况。结果：1．对照组各时点血浆心肌肌钙蛋白I(cTnI)、磷酸肌酸激酶(CK)、磷酸肌酸激酶同工酶(CK-MB)、乳酸脱氢酶(LDH)含量明显高于实验组，差异均有显著性(附表)。2．心肌肌钙蛋白Ⅰ的敏感性优于心肌酶谱。3．实验组心脏自动复跳率80％，对照组心脏自动复跳率65％，差异有显著性(P＜0.01)。4．实验组肾上腺素使用比率5％；对照组肾上腺素使用比率20％，LCOS 2例，差异有显著性(P＜0.05)。结论：1．风湿性心病患者围术期，血浆中心肌肌钙蛋白Ⅰ(cTnI)、磷酸肌酸激酶(CK)、磷酸肌酸激酶同工酶(CK-MB)、乳酸脱氢酶(LDH)均发生变化，但心肌肌钙蛋白Ⅰ的变化更敏感。这与其它文献报告相一致。2．川芎嗪预处理明显影响血浆中心肌肌钙蛋白Ⅰ和磷酸肌酸激酶(CK)、磷酸肌酸激酶
安徽医科大学硕士学位论文
同工酶(CK一MB)、乳酸脱氢酶(LDH)的变化，心肌肌钙蛋白工的变化更敏感;3
川芍嗓预处理能减轻心肌缺血再灌注损伤。
Objective:.This articles studys the change of the release of cardiac troponin I during the heart valves replaced after Tetramethylpyrazine preconditioning, To approach Tetramethylpyrazine's preserving the myocardium
Method: from 2003 year 7 month to 2004 year 4 month 40 patients finally diagnosed as rheumaetic heart disease were randomly divided into the Tetramethylpyrazine group (A group,n=20) and the control group (B group,n=20).The patients of A group were injected with Tetramethylpyrazine(4mg/kg) before operation.the Venous blood samples between two grounps were taken at the following times before using Tetramethylpyrazine, thirties minutes after the aorta blocked, thirties minutes after aorta opened,24 hours 48 hours 72 hours and 150 hours after operation. We measure the concentrations of cTnI,CK,CK-MB and LDH.record the rate of automatical heart ambi-beat. and inotropic agent use after operation complication and information of curing
Results: 1.every time point content of cTnI,CK,CK-MB and LDH in the control group was obviously superer than that in the Tetramethylpyrazine group (P<0.01 < 0.05, seen in attached table2) . The sensitivity of cTnI was superer than that of the myocard zymogram 3. the rate of automatical heart ambi-beat is eighty percent in the Tetramethylpyrazine group,but sixty-five percent in the control group,The disparity of
two groups is significant (P<0.01 0.05) 4.The rate of adrenalin use is five percent in the Tetramethylpyrazine group,but twenty percent in the control group.one was dead after operation in the Tetramethylpyrazine group,three were dead in the control group and two LCOSes happent
Conclusion: : 1.Plasma cTnI and plasma CK ,CK-MBand LDH levels change obviously. But cTnI is more sensitive these are coincident with other dicuments; 2. Tetramethylpyrazine preconditioning can affect plasma cTnI ,CK ,CK-MBand LDH levels obviousely. But cTnI is more sensitive-, 3. Tetramethylpyrazine can mitigate ischemical reperfusion injury of myocardial cell
安徽医科大学硕士学位论文
同工酶(CK一MB)、乳酸脱氢酶(LDH)的变化，心肌肌钙蛋白工的变化更敏感;3
川芍嗓预处理能减轻心肌缺血再灌注损伤。
Objective:.This articles studys the change of the release of cardiac troponin I during the heart valves replaced after Tetramethylpyrazine preconditioning, To approach Tetramethylpyrazine's preserving the myocardium
Method: from 2003 year 7 month to 2004 year 4 month 40 patients finally diagnosed as rheumaetic heart disease were randomly divided into the Tetramethylpyrazine group (A group,n=20) and the control group (B group,n=20).The patients of A group were injected with Tetramethylpyrazine(4mg/kg) before operation.the Venous blood samples between two grounps were taken at the following times before using Tetramethylpyrazine, thirties minutes after the aorta blocked, thirties minutes after aorta opened,24 hours 48 hours 72 hours and 150 hours after operation. We measure the concentrations of cTnI,CK,CK-MB and LDH.record the rate of automatical heart ambi-beat. and inotropic agent use after operation complication and information of curing
Results: 1.every time point content of cTnI,CK,CK-MB and LDH in the control group was obviously superer than that in the Tetramethylpyrazine group (P<0.01 < 0.05, seen in attached table2) . The sensitivity of cTnI was superer than that of the myocard zymogram 3. the rate of automatical heart ambi-beat is eighty percent in the Tetramethylpyrazine group,but sixty-five percent in the control group,The disparity of
two groups is significant (P<0.01 0.05) 4.The rate of adrenalin use is five percent in the Tetramethylpyrazine group,but twenty percent in the control group.one was dead after operation in the Tetramethylpyrazine group,three were dead in the control group and two LCOSes happent
Conclusion: : 1.Plasma cTnI and plasma CK ,CK-MBand LDH levels change obviously. But cTnI is more sensitive these are coincident with other dicuments; 2. Tetramethylpyrazine preconditioning can affect plasma cTnI ,CK ,CK-MBand LDH levels obviousely. But cTnI is more sensitive-, 3. Tetramethylpyrazine can mitigate ischemical reperfusion injury of myocardial cell
引文
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77 Murry CE, Jennings RB, Reimer KA. Preconditioning with ischemica:A delay of lethal cell injury in ischemi cmyocardium. Circulation, 1986, 74: 1124-1136.
78 Ovize M, KlonerRA, Hale SL cornarycyclic flow variations" precondition" ischemic myocardium. Circulation, 1992,85:779-789
79 Hale SL, Kloner RA. Effect of ischemic preconditioning on regional myocardial blood flow in the rabbit heart. Cor Art Dis, 1992,3:133-140
80 Schott RJ, Rohman S, Branner ER Ischemic precondition reduces infract size in swine myocardium. Cire Res, 1990,66:1133-1144
81 Speechly-Dick ME, Grover GJ, Yellon DM Does ischemic preconditioning in the human involve protein kinase C and the ATP-dependent K~+ channel, Studies of contractile ruction after simulated ischemic in an atrail in vitro model. Cire Res, 1995,77:1030-1035
82 Liu GS, Thornton J, Van Winkle DM protection against infarction afforded by preconditioning is meditated by A1 adenosine receptors in rabbit heart Circulation, 1991,84:350-356
83 Goto M, Liu Y, Yang X-M.Role of bradykinin in rabbit heart. Cinc Res, 1995,77:611-621
84 Vegh A, Papp JG, Szkeres L. Prevention by a inhibitor of the L-Arginine-ni-tric oxide pathway of the antiarrythmic effect of bradkinin in anaesthetized dogs. Br J phammacol, 1993,110:18
85 Schultz JEJ, HsuAK, Gross GJ.Morphine mimics the cardioprotective effect ischemic preconditioning via a gliben-clamide-sensitive mechanism in rat heart. Cite Res, 1996,78:1100-1104
86 傅李莉，夏强，沈岳良)内源性阿片物质与大鼠缺血预处理的心肌保护作用．生理学
报，1998，50(6)P：603-610
87 Speechly-Dick ME, Mocanu MM, Yellon DM. Preconditioning in the rat. Cire Res, 1994,75:586
88 Maulik N, Watanabe M, Zu Y-L. Ischemic preconditioning triggers the activation of MAP kinases and MAPKAP kinase two in rat hearts. FEBS Lett, 1996,396:233-237
89 Vahlhaus C, Schulz R, Post H prevention of ischemic preconditioning only by combined inhibition of protein kinase C and protein tyrosine kinase in pigs. J Mol Cell Cardiol, 1998,30:197-209
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