左-卡尼汀在心内直视手术中对心肌的保护作用(1)
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[摘要] 目的:探讨心内直视手术中外源性左-卡尼汀(L-CN)对心肌的保护作用。方法:选取心内直视手术的患者32例,随机分为实验组和对照组。实验组术中于冷晶体心脏停搏液中按10 g/L加入L-CN,行冠状动脉顺行灌注;对照组仅使用冷晶体停搏液灌注。两组均于术前、主动脉阻断开放后2、24、72 h各时点采取静脉血,测心肌酶(CK、CK-MB),肌钙蛋白I(cTnI)和肌钙蛋白T(cTnT)水平。结果:两组患者CK、CK-MB, cTnT、cTnI水平在术前比较,差异无统计学意义(P>0.05),于主动脉开放后均有明显的升高。实验组CK、 CK-MB升高程度较对照组低(P<0.05)。实验组cTnT、cTnI升高程度在2、24 及72 h较对照组低(P<0.05),2 h尤其明显(P<0.01)。结论:在心内直视手术中,左-卡尼汀加入心脏停搏液后可明显改善心脏能量供应,有效减少心肌细胞损伤,对心肌起到明显保护作用。
[关键词] 体外循环;心内直视手术;停搏液;左-卡尼汀;心肌保护
[中图分类号] R654 [文献标识码]A [文章编号]1674-4721(2010)06(a)-048-02
The myocardial protective effects of L-carnitine under open cardiac operation
REN Mingming,LI Jinglai,HAN Zhen,CHENG Ying,WU Yongqian
(Department of Cardiovascular Surgery, Peking University Shenzhen Hospital,Guangdong Province, Shenzhen 518036,china)
[Abstract] Objective:To investigate the myocardial protective effects of L-carnitine in patients with heart disease undergoing open cardiacoperation under cardio-pulmonary bypass(CPB).Methods:Thirty-two patients undergoing open cardiacoperation were randomly divided into test group(n=16) and control group(n=16). L-carnitine was put in the cold crystal cardiac arresting liquid in the test group(10 g/L), other experimental conditions were the same between two groups. Before operation,at 2,24,72 h after the aortic declamping, venous blood was drawn to test the level of serum creatine kinase(CK),CK-MB isozyme,cardiac Troponin I(cTnI),cardiac Troponin T (cTnT). Results:The level of CK,CK-MB,cTnT,cTnI in blood samples increased indifferencely in two groups before operation, increased significantly in two groups after the aortic declamping.The increase magnitude of CK,CK-MB in control group was more than test group (P<0.05); The increase magnitude of cTnT,cTnI in control group was more than test group at 2,24,72 h after declamping, much more at 2 h(P<0.01).Conclusion:L-carnitine improves the service of the energy in myocardium undergoing open cardiac operation under CPB obviously, decreases the damage of the cells in myocardium effectly and has a good protective effect on myocardium in patients ......
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