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1、心脏瓣膜置换术中应用1,6-二磷酸果糖的心肌保护作用研究作者：黄志勇,姬尚义,王毅,叶小青,吴贵云【摘要】目的探讨1,6-二磷酸果糖(FDP)在心脏瓣膜置换术中对心肌的保护作用。方法瓣膜置换术患者60例，随机分为实验组和对照组，每组30例。实验组于CPB前分别从中心静脉滴入和经心肌保护液中加入FDP150mg/kg，对照组则以等量生理盐水代替。两组于围术期不同时点中心静脉采血检测心肌肌钙蛋白I(cTnI)、肌酸激酶同功酶(CKMB)、乳酸脱氢酶(LDH)、肌红蛋白(MYO);临床观察心脏自动复跳情
2、况、心电图S-T段改变、正性肌力药用量、术后拔管时间、ICU滞留时间等项目;在电境下观察心肌超微结构的变化。结果两组cTnI、CKMB、LDH、MYO于主动脉开放后逐步升高，明显高于阻断前(P<0.05)。实验组这些指标升幅均小于对照组，cTnI、CKMB于开放升主动脉后30min及CPB停机后6h显著低于对照组(P<0.05)，且实验组心脏自动复跳率高、术中S-T段改变轻微、正性肌力药用量少、ICU滞留时间短;电镜亦显示实验组心肌超微结构损伤明显轻于对照组。结论1，6-二磷酸果糖在心
3、脏瓣膜置换术中具有良好的心肌保护作用。【关键词】心脏瓣膜置换术;1，6-二磷酸果糖;体外循环;心肌保护10 Abstract:OBJECTIVEToevaluateprotectiveeffectsofFructose-1,6-bisphosphate(FDP)onmyocardialstructureandfunctionduringcardiacvalvereplacementsurgery.METHODS60patientsundergoingcardiacvalvereplacement
4、wererandomlyanddouble-blindedselectedtoatreatmentgroupandacontrolgroup(30casesforeach).Beforeinitiationofcardiopulmonarybypass(CPB),FDPwasadministeredinthetreatmentgroupatdosageof150mg/kgbythecentralveinandmixedwithcardioplegiasolutioninCPBline,respec
5、tively.AscomparedwithFDP,incontrolgroupthesamevolumeofnormalsalinewasgivenintothepatients.PlasmaconcentrationsofcardiacbiomarkersincludingCardiactroponinI(cTnI),CreatinekinaseMBisoenzyme(CKMB),Lactatedehydrogenase(LDH),Myoglobin(MYO)weremeasuredatdiff
6、erenttimepointsinthetwogroups,meanwhile,Clinicaldataincludingheartresuscitation,ST-segmentdeviations,dosagesofpositiveinotropicagent,timeofICUstaywererecorded.Microstructuresofmyocardialcellwerescannedbyelectricalmicroscope.RESULTSTheplasmaconcentrati
7、onsofthecardiacbiomarkersafterclampingofftheaortainbothgroupsweresignificantlyhigherthanthosebeforeonsetofclampingtheaorta(P<0.05),theconcentrationsof10allthecardiacbiomarkersmeasuredinthetreatmentgroupweremuchlowerthanthoseincontrolgroup.cTnI、CKMB
8、showedsignificantlowerlevelattimepointsof30minutesafterclampingofftheaortaand6hoursaftertheendofCPB(P<0.05).Clinicalobservationsshowedthattreatmentgrouphadsuccessfulheartresuscitation,mildST-segmentdeviations,lesspositiveinotropicsupportand
