摘要
目的探讨米力农在伴有肺动脉高压的婴幼儿体外循环中的心肌保护作用。方法 30例伴有中重度肺动脉高压的室间隔缺损婴幼儿随机分成米力农组和对照组。米力农组在主动脉阻断前15min静脉输注米力农负荷量,然后静脉维持;对照组以同样方法注入生理盐水。所有患儿均于麻醉诱导后开胸前(T1),主动脉开放后0.5h(T2)、3h(T3)、6h(T4)、24h(T5)采桡动脉血测定心肌肌钙蛋白-I(cTnI)、肌酸激酶同工酶(CK-MB)、丙二醛(MDA)、超氧化物歧化酶(SOD)水平;用电镜观察两组体外循环前后心肌超微结构变化,并记录分析心脏自动复跳率﹑机械通气时间及ICU监护时间。结果与T1比较,两组其余各时点CK-MB、cTnI、MDA值均升高,SOD降低;在主动脉开放后米力农组cTnI、CK-MB、MDA低于对照组,而SOD高于对照组。组织学上米力农组心肌损伤明显轻于对照组。米力农组心脏自动复跳率高于对照组,机械通气时间及ICU监护时间差异无统计学意义。结论米力农能减轻婴幼儿体外循环手术中的心肌损害,对心肌缺血再灌注损伤有保护作用。
Objective To investigate the myocardial protective effect of milrinone in infants with pulmonary hypertension under cardiopulmonary bypass （ CPB）. Methods Thirty infants with ventricular septal defect （VSD） suffering from moderate to severe pulmonary hypertension were randomly divided into milrinone group and control group. The patients in milrinone group were given milrinone in a bolus dose before aortic clamping and followed by a continuous vein infusion. In control group,the same amount of NS was infused instead. In all patients, blood samples were taken to measure the level of cTnI, C K- M B, M DA and SOD before thoracotomy （T1）,0.5h （T2 ）,3h（ T3 ）, 6h（T4 ） and 24h（T5 ） after aortic declamping. Myocardial biopsy was performanced for uhrastructure examination with electron microscope before CPB and O. 5h after CPB. The rate of automatic resume pulsating,the duration of mechanical ventilation and ICU settling were ana- lyzed and calculated. Results After aortic declamping,the levels of CK - MB, cTnI, MDA in milrinone group were significantly lower than those of control group and the level of SOD were higher than those in control group. The histological injury of myocytes in milrinone group was less severe than that in control group. The rate of automatic resume pulsating in milrinone group was higher than that in control group（ P 〈 0. 05 ）. The duration of mechanical ventilation and ICU settling had no significant difference between two groups （P 〉 0.05 ）. Conclusion Milrinone could reduce the myocardial injury in cardiopulmonary bypass in infants with pulmonary hypertension and protect the heart from ischemia - reperfusion injury.
出处
《医学研究杂志》
2013年第5期166-169,共4页
Journal of Medical Research
关键词
米力农
肺动脉高压
婴幼儿
体外循环
心肌保护
Milrinone
Pulmonary hypertension
Infants
Cardiopulmonary bypass
Myocardial protection
