资源描述：
《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.doc》由会员上传分享，免费在线阅读，更多相关内容在学术论文-天天文库。
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
2、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 Abstract:OBJECTIVEToevaluatepro
3、tectiveeffectsofFructose-1,6-bisphosphate(FDP)onmyocardialstructureandfunctionduringcardiacvalvereplacementsurgery.METHODS60patientsundergoingcardiacvalvereplacementwererandomlyanddouble-blindedselectedtoatreatmentgroupandacontrolgroup(30casesforeach).Beforeinitiationofcardiopulmonarybypass(C
4、PB),FDPwasadministeredinthetreatmentgroupatdosageof150mg/kgbythecentralveinandmixedwithcardioplegiasolutioninCPBline,respectively.AscomparedwithFDP,incontrolgroupthesamevolumeofnormalsalinewasgivenintothepatients.PlasmaconcentrationsofcardiacbiomarkersincludingCardiactroponinI(cTnI),Creatinek
5、inaseMBisoenzyme(CKMB),Lactatedehydrogenase(LDH),Myoglobin(MYO)weremeasuredatdifferenttimepointsinthetwogroups,meanwhile,Clinicaldataincludingheartresuscitation,ST-segmentdeviations,dosagesofpositiveinotropicagent,timeofICUstaywererecorded.Microstructuresofmyocardialcellwerescannedbyelectrica
6、lmicroscope.RESULTSTheplasmaconcentrationsofthecardiacbiomarkersafterclampingofftheaortainbothgroupsweresignificantlyhigherthanthosebeforeonsetofclampingtheaorta(P<0.05),theconcentrationsofallthecardiacbiomarkersmeasuredinthetreatmentgroupweremuchlowerthanthoseincontrolgroup.cTnI、CKMBshowe
7、dsignificantlowerlevelattimepointsof30minutesafter5clampingofftheaortaand6hoursaftertheendofCPB(P<0.05).Clinicalobservationsshowedthattreatmentgrouphadsuccessfulheartresuscitation,mildST-segmentdeviations,lesspositiveinotropicsupportandsho
