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戊乙奎醚对婴儿体外循环下心脏手术缺血再灌注心肌的保护作用
The Effect of Penehyelidine Hydrochloride on Myocardium during Cardio Pulmonary Bypass Infant Heart Surgery

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DOI:
作者:
李黎，魏晓永，姜丽华，王涛
LI Li, WEI Xiao-yong, JIANG Li-hua, WANG Tao.
作者单位:
郑州大学第三附属医院
Department of Anesthesiology, Third Affiliated Hospital, Zhengzhou Medical University , Zhengzhou 450052， China
关键词:
盐酸戊乙奎醚 体外循环 缺血再灌注 心肌保护 肌钙蛋白 心肌酶谱
Penehyclidine hydrochloride, CPB, Ischemia reperfusion injury(IR) myocardium protection, Troponin, Myocardium zymogram
摘要:
目的 观察婴儿体外循环心脏直视手术中，盐酸戊乙奎醚对心肌缺血再灌注损伤的保护作用。方法 择期于体外循环下行房间隔、室间隔缺损修补术的先天性心脏病患儿20例，1月-1岁，心功能Ⅰ-Ⅱ级，ASA分级Ⅱ级，随机分为两组：对照组（C组）和盐酸戊乙奎醚组（P组）。P组患儿于麻醉诱导时给予0.05mg•kg-1的戊乙奎醚静脉推注,C组患儿给以相同容量的生理盐水静脉推注。手术前24小时（T1），术后1小时(T2)以及术后24小时(T3)采集静脉血检测肌钙蛋白（cTnT）和心肌酶谱（AST、CK、CKMB、HBDH、LDH）的血浆浓度。主动脉阻断20分钟以及主动脉开放20分钟的两个时间点分别剪取小量未被钳夹的右心耳心肌组织经HE染色，在光镜下观察其结构改变并摄取照片。结果 与T1相比，P组C组在T2、T3时刻血清肌钙蛋白（cTnT）和心肌酶谱（AST、CK、CK-MB、HBDH、LDH）浓度均升高（P＜0.05），但P 组在T2、T3时刻血清肌钙蛋白浓度均低于C 组(P＜0.05)；在T2、T3 时刻，P 组血清心肌酶谱（AST、CK、CKMB、HBDH、LDH）浓度与C 组同时刻相比，P 组低于C组（P＜0.05)；与C 组相比较，P组心肌组织形态明显改善。结论 预先静脉注射0.05mg•kg-1盐酸戊乙奎醚,可降低体外循环后血清肌钙蛋白和心肌酶谱的升高，减轻心肌损伤，对缺血再灌注心肌有一定的保护作用。
Objective To observe the effect of penehyclidine hydrochloride on Ischemia reperfusion injury myoeardium during the operation on myocardial impact in infants heart surgery. Methods 20 patients, heart functionⅠ-Ⅱ, ASAⅡ, aged 1 month-1 year old, scheduled for congenital atrial septal defect or ventricular septal defect repair in this study were randomized into two groups:PenehyclidineHydrochloride group ( P group) and control group ( C group). Infants in P group were given 0.05mg•kg-1 Penehyclidine Hydrochloride intravenously during induction of anesthesia. Infants in group C were given the same volume of Sodium Chloride intravenously. The serum concentration of troponin (cTnT) and myocardium zymogram (AST、CK、CK-MB、HBDH、LDH ) in venous blood were detected at the preoperative time, one hour after operation and 24 hours after operation. At the time 20 minutes after aortic occlusion and 20 minutes after aortic patefaction, we cut a small amount of myocardium of right atrium which had not been clampped during the surgery. In order to fix, the tissues were submerged in 10% Formalin immedialtely. Then HE stain followed. Observed them through 20×10 times high power microscope and took photos. Results Compared with that at T1, the serum concentration of cTnT and myocardium zymogram (AST,CK,CK-MB,HBDH,LDH) at T2 and T3 were significantly higher(P＜0.05) in the two groups. And the serum concentration of cTnT and myocardium zymogram (AST,CK,CK-MB,HBDH,LDH) in group P were significantly lower than that in group C at the three corresponding times( P＜0.05). And at T2 and T3 times the serum concentration of cTnT and myocardium zymogram(AST,CK,CK-MB,HBDH,LDH) in group P were significantly lower than that in group C (P＜0.05). The microstructure of heart tissues in P group were significantly better than those in C group.Conclusion Penehyclidine Hydrochloride injection intravenously 0.05mg/Kg plays an important role in protection myocardium from Ischemia reperfusion injury during CPB operations in infants.

 

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