Clinical study of combined treatment with creatine phosphate sodium for myocardial protection in endoscopic heart surgery
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.
Myocardial ischemia and reperfusion injuryCreatine phosphate sodiumPre-treatmentPost-treatmentCombined treatmentEndoscopic heart surgery
万方数据
维普
