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左卡尼汀对行非体外循环冠状动脉搭桥术患者微循环和心肌酶的影响
作者:郑雄  武云峰  朱军辉  刘磊 
单位:阜阳市人民医院 心胸外科, 安徽 阜阳 236000
关键词:左卡尼汀 非体外循环冠状动脉搭桥术 心肌酶 微循环 
分类号:R654.2
出版年·卷·期(页码):2018·46·第十期(1111-1114)
摘要:

目的:探讨左卡尼汀对行非体外循环冠状动脉搭桥术患者微循环、心肌酶的影响。方法:采用回顾性分析方法,选择2015年1月至2018年1月我院收治的80例行非体外循环冠状动脉搭桥术患者,分为观察组和对照组各40例。观察组患者术前使用左卡尼汀,对照组患者术前给予同体积生理盐水。比较两组患者麻醉诱导后(T0)、主动脉侧壁钳开放后30 min(T1)、术后12 h(T2)及24 h(T3)静脉血微循环、心肌酶变化情况。结果:两组患者T2、T3时血清乳酸(LA)水平较T0时升高,混合静脉血氧饱和度(SvO2)及平均动脉压(MAP)较T0时降低(P<0.05);T2、T3时观察组LA水平低于对照组,SvO2及MAP高于对照组(P<0.05)。两组患者T1、T2、T3时心肌肌钙蛋白I(cTnI)、肌酸激酶同工酶(CK-MB)水平较T0时升高(P<0.05);T1、T2、T3时观察组cTnI、CK-MB水平低于对照组(P<0.05)。两组患者T1、T2、T3时血浆超氧化物歧化酶(SOD)活性较T0时降低,丙二醛(MDA)浓度较T0时升高(P<0.05);T1、T2、T3时观察组血浆SOD活性高于对照组,MDA浓度低于对照组(P<0.05)。结论:左卡尼汀具有改善行非体外循环冠状动脉搭桥术患者微循环、保护心肌的作用。

Objective:To investigate the effects of L-carnitine on microcirculation and myocardial enzymes in patients undergoing off-pump coronary artery bypass surgery. Methods:A retrospective analysis was conducted on 80 patients who had undergone off-pump coronary artery bypass surgery in our hospital from January 2015 to January 2018. The patients were divided into observation group and control group with 40 cases in each group. Patients in the observation group were given L-carnitine before surgery, and patients in the control group were given the same volume of normal saline before surgery. The microcirculation and myocardial enzyme changes in venous blood were compared between the two groups after induction of anesthesia (T0), aortic wall forceps open for 30 min (T1), postoperative 12 h (T2) and 24 h (T3).Results:In both two groups, the levels of lactic acid (LA) in T2 and T3 were higher than those in T0, and the levels of oxygen saturation of mixed venose blood (SvO2) and mean arterial pressure (MAP) were lower than those of T0 (P<0.05). The levels of LA in the observation group at T2 and T3 were lower than those in the control group, and the levels of SvO2 and MAP in the observation group were higher than those in the control group at the same period (P<0.05). The levels of cardiac troponin (cTnI) and creatine kinase isoenzyme (CK-MB) in T1, T2 and T3 were significantly higher than those in T0 (P<0.05). The levels of cTnI and CK-MB in the observation group were lower than those in the control group at T1, T2 and T3 (P<0.05). In both two groups, the plasma superoxide dismutase (SOD) activity at T1, T2 and T3 was lower than that at T0, and the malondialdehyde (MDA) concentration at T1, T2 and T3 was higher than that at T0 (P<0.05). The plasma SOD activity of the observation group at T1, T2 and T3 was higher than that of the control group, and the MDA concentration was lower than that of the control group at the same period (P<0.05).Conclusion:L-carnitine has the effect of improving microcirculation and protecting myocardium in patients undergoing off-pump coronary artery bypass surgery.

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