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 2.0g;联合处理组:体外循环开始前静脉注射CP 1.0g,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1d和术后2d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、x2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],差异均有统计学意义(均P＜0.05).联合处理组术毕的cTnⅠ水平[(4.65±1.07)μg/L]低于预处理组[(5.86±0.99)μg/L],差异有统计学意义(P＜0.05);联合处理组术后1 d、术后2d的cTnⅠ水平[(6.54±0.86)μg/L、(6.24±1.10)μg/L]均低于预处理组[(8.02± 1.04)μg/L、(7.22±1.07)μg/L]和后处理组[(9.01±0.87)μg/L、(7.45±1.08)μg/L],差异均有统计学意义(均P＜0.05).联合处理组术后1d的BNP水平[(168.64±20.19)ng/L]低于预处理组[(185.65±25.13)ng/L],差异有统计学意义(P＜0.05);联合处理组术后2 d的BNP水平[(134.77±22.14)ng/L]均低于预处理组[(169.33±26.07)ng/L]和后处理组[(157.10±28.16)ng/L],差异均有统计学意义(均P＜0.05).结论 与CP预处理或后处理比较,CP联合处理更能有效地减轻腔镜下心内直视手术心肌I/R损伤,改善心功能.
Abstract
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 Ⅲin 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 cardiopulmonary bypass assistance,automatic cardiac beat recovery,and postoperative use of dopamine and epinephrine were compared among the three groups.The levels of blood creatine kinase isoenzyme(CK-MB),cardiac troponin Ⅰ(cTnⅠ),and brain natriuretic peptide(BNP)were compared among the three groups before surgery,at the end of surgery,and 1 d and 2 d after surgery.F test,LSD test,x2 test,Fisher exact probability method,and rank sum test were used.Results The proportion of epinephrine use within 48 h after surgery in the combined treatment group(1/12)was lower than that in the pre-treatment group(6/12)and post-treatment group(5/12),with a statistically significant difference(P＜0.05).At the end of surgery,the level of CK-MB in the combined treatment group[(12.14±4.98)U/L]was lower than that in the pre-treatment group[(17.51±5.14)U/L],with a statistically significant difference(P＜0.05).One d and 2 d after surgery,the levels of CK-MB in the combined treatment group[(27.17±11.25)U/L and(17.10±8.27)U/L]were lower than those in the pre-treatment group[(37.58±11.15)U/L and(26.46±8.98)U/L]and post-treatment group[(39.54± 14.27)U/L and(24.28±7.07)U/L],with statistically significant differences(all P＜0.05).At the end of surgery,the level of cTnⅠ in the combined treatment group[(4.65±1.07)μg/L]was lower than that in the pre-treatment group[(5.86±0.99)µg/L],with a statistically significant difference(P＜0.05).One d and 2 d after surgery,the levels of cTnⅠ in the combined treatment group[(6.54±0.86)μg/L and(6.24±1.10)μg/L]were lower than those in the pre-treatment group[(8.02±1.04)μg/L and(7.22± 1.07)μg/L]and post-treatment group[(9.01±0.87)μg/L and(7.45±1.08)μg/L],with statistically significant differences(all P＜0.05).The BNP level of the combined treatment group[(168.64± 20.19)ng/L]was lower than that of the pre-treatment group[(185.65±25.13)ng/L]1 d after surgery,with a statistically significant difference(P＜0.05).The BNP level of the combined treatment group[(134.77±22.14)ng/L]was lower than that of the pre-treatment group[(169.33±26.07)ng/L]and post-treatment group[(157.10±28.16)ng/L]2 d after surgery,with statistically significant differences(both P＜0.05).Conclusion The combined treatment with CP is more effective on reducing myocardial ischemia and reperfusion injury during endoscopic heart surgery when compared to pre-treatment or post-treatment with CP.
基金项目
佛山市医学科研项目(2022)(20220362)
维普
万方数据