| 摘要: |
| 目的观察辅酶复合物在体外循环心内直视术中的心肌保护作用。方法先天性心脏病患儿(NYHA分级为Ⅰ～Ⅱ级）40例,随机分为辅酶复合物组和阴性对照组 (每组20例）。辅酶复合物组患儿术日开胸前静滴辅酶复合物、术后连续3 d静滴,1次/d,剂量同前；阴性对照组不用辅酶复合物干预。分别在术前(T1)、主动脉阻断30 min(T2)、主动脉开放60 min(T3)、术后24 h(T4)、术后48 h(T5)、术后72 h(T6)、术后1周(T7),经外周静脉取血,测定丙二醛(MDA)、白介素8(IL-8）、肌钙蛋白I (CTnI)浓度。分别在主动脉阻断前和主动脉开放15 min取1 mm3右心耳组织,电镜下观察超微结构的变化。结果两组患儿在体外循环后MDA、IL-8、CTnI含量均明显升高,而辅酶复合物组患儿MDA在主动脉开放后60 min、术后24、48 h低于对照组(P<0.05或0.01),IL-8在主动脉阻断30 min,主动脉开放后60 min,术后24、48 h低于对照组(P<0.01),CTnI值在主动脉开放后60 min,术后24、48、72 h低于对照组(P<0.05或0.01)。主动脉开放后,两组患儿心肌细胞超微结构均较主动脉阻断前有不同程度损伤,且辅酶复合物组轻于对照组。结论辅酶复合物可能通过减少自由基和炎症因子的产生,减少CTnI释放,在体外循环心内直视术中起心肌保护作用。 |
| 关键词: 辅酶复合物 体外循环 心脏外科手术 心肌保护 再灌注损伤 |
| DOI：10.3724/SP.J.1008.2010.0173 |
| 投稿时间：2009-12-26修订日期：2010-01-23 |
| 基金项目:南通市社会发展科技计划指令性项目(S2006025）. |
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| Protective effect of coenzyme complex on myocardium under cardiopulmonary bypass in open heart surgery |
| WANG Hao1, XUE Qun2*, ZHONG Chong-jun1, ZHOU Feng1, ZHU Chang-lai3, LIU Lin1, XIA Chun-qiu1 |
| (1. Department of Cardiothoracic Surgery, Second Affiliated Hospital to Nantong University, Nantong 226001, Jiangsu, China;2. Department of Cardiothoracic Surgery, First Affiliated Hospital to Nantong University, Nantong 226001, Jiangsu, China;3. Department of Electron Microscope, Nantong University, Nantong 226001, Jiangsu, China) |
| Abstract: |
| ObjectiveTo study the protective effect of coenzyme complex on myocardium under cardiopulmonary bypass in open heart surgery.MethodsForty patients with congenital heart disease scheduled for open heart surgery under cardiopulmonary bypass (CPB) were evenly randomized into 2 groups. Coenzyme complex (1 bottle/10 kg) was given to the experimental group but not to the control group. The venous blood samples were collected at following time points. T1: during anesthetic induction period (baseline), T2: half an hour after aorta clamp, T3: one hour after aorta clamp opened, T4: 24 h after operation, T5: 48 h after operation, T6:72 h after operation, and T7:one week after operation. The levels of cardiac troponin I (CTnI), interleukin-8(IL-8) and maleic dialdehyde (MDA) were measured. Right atrial appendage specimen was taken and processed for transmission electron microscope observation of myocardial ultrastructure.ResultsThe levels of CTnI, IL-8, and MDA were significantly increased in the two groups during CPB, but the values in the experimental group were lower than those in the control group at following time points: (CTnI) one hour after aorta clamp opened and 24 h, 48 h, 72 h after operation (P<0.05 or 0.01); (IL-8) half an hour after aorta clamp, one hour after aorta clamp opened and 24 h, 48 h, 72 h after operation (P<0.01); and (MDA) one hour after aorta clamp opened and 24 h, 48 h after operation (P<0.05 or 0.01). The injury of myocardial cellular ultrastructure was seen in each group after aorta clamp was opened by different extents. However, more severe disorganization of myocardial cellular ultrastructure could be seen in the control group. ConclusionCoenzyme complex may reduce the production of oxygen free radical and inflammatory factor, subsequently reduce the release of CTnI, protecting myocardium under cardiopulmonary bypass in the open heart surgery. |
| Key words: coenzyme complex extracorporeal circulation cardiac surgical procedures myocardial protection myocardial reperfusion injury |
