磷酸肌酸钠对体外循环下房室间隔缺损修补术患儿心肌能量代谢和心肺功能的影响

doi:10.3760/cma.j.issn.1007-1245.2022.05.015

国际医药卫生导报 ›› 2022, Vol. 28 ›› Issue (5): 656-662.DOI: 10.3760/cma.j.issn.1007-1245.2022.05.015

磷酸肌酸钠对体外循环下房室间隔缺损修补术患儿心肌能量代谢和心肺功能的影响

张武¹ 李贻霞² 吴丽灵² 蒙丽婵³ 霍保善⁴ 詹锋¹ 杨凯² 胡旭东²

¹南方医科大学附属佛山医院心胸外科，佛山　528000； ²南方医科大学附属佛山医院麻醉科，佛山　528000； ³南方医科大学附属佛山医院供应室，佛山　528000； ⁴南方医科大学附属佛山医院重症医学科，佛山　528000

收稿日期:2021-12-14 出版日期:2022-03-01 发布日期:2022-04-01
通讯作者: 胡旭东，Email：huxudong65@163.com
基金资助:
2022年度佛山市医学科研课题（20220362）

Effect of sodium creatine phosphate on myocardial energy metabolism and cardiopulmonary function in children taking atrio-ventricular septal defect repair under cardiopulmonary bypass

Zhang Wu¹, Li Yixia², Wu Liling², Meng Lichan³, Huo Baoshan⁴, Zhan Feng¹, Yang Kai², Hu Xudong²

¹Department of Cardiothoracic surgery, Foshan Hospital Affiliated to Southern Medical University, Foshan 528000, China; ²Department of Anesthesiology, Foshan Hospital Affiliated to Southern Medical University, Foshan 528000, China; ³Supply Room, Foshan Hospital Affiliated to Southern Medical University, Foshan 528000, China; ⁴Critical Medical Unit, Foshan Hospital Affiliated to Southern Medical University, Foshan 528000, China

Received:2021-12-14 Online:2022-03-01 Published:2022-04-01
Contact: Hu Xudong, Email: huxudong65@163.com
Supported by:
Medical Research Project of Foshan in 2022 (20220362)

摘要/Abstract

摘要： 目的　探讨磷酸肌酸钠液冷晶体停跳液对体外循环下房室间隔缺损修补术患儿心肌能量代谢和心肺功能的影响。方法　采用前瞻性随机对照研究。选取在南方医科大学附属佛山医院接受体外循环下行手术治疗的房室间隔缺损患儿48例，采用随机数字表法分为试验组和对照组，每组24例。对照组患儿男14例、女10例，年龄（7.2±3.4）岁，体质量（20.2±5.8 ）kg；试验组患儿男16例、女8例，年龄（7.0±3.4）岁，体质量（20.4±9.5）kg。对照组采用常规高钾冷液晶心脏停搏液，试验组在常规的冷晶体停跳液中加入磷酸肌酸钠，浓度为10 mmol/L。两组患儿均在体外循环下行心内直视房室间隔缺损修补术。观察和记录两组患儿体外循环时间、主动脉阻断时间、体外循环辅助时间、心脏自动复跳情况，以及术后多巴胺和肾上腺素的使用情况和术后呼吸机支持时间。分别于体外循环前（T0）、主动脉开放5 min（T1）、主动脉开放30 min（T2）、停机后4 h（T3）、停机后24 h（T4）抽取动脉血，采用免疫荧光法测定血肌酸激酶同工酶（CK-MB）和心肌钙蛋白I（cTnI）水平。分别于术前和术后1 d采取静脉血，采用高效液相法测定三磷酸腺苷（ATP）、二磷酸腺苷（ADP）、单磷酸腺苷（AMP）、磷酸肌酸（CP）的含量。采用t检验、卡方检验和方差分析行统计学处理。结果　试验组和对照组的体外循环时间［（63.4±13.4）h比（67.1±19.8）h］、主动脉阻断时间［（30.9±11.6）h比（32.1±14.5）h］、体外循环辅助时间［（18.3±10.1）h比（22.3±9.3）h］以及心脏自动复跳率［100.0%（24/24）比100.0%（24/24）］比较差异均无统计学意义（均P>0.05）。术后呼吸辅助时间试验组短于对照组［（6.7±2.3）h比（7.9±1.4）h］，差异有统计学意义（t=2.18，P=0.03）。试验组的CK-MB在T1、T2、T3和T4时点均明显低于对照组［（22.4±5.3）U/L比（27.5±7.7）U/L、（68.5±11.9）U/L比（80.4±16.7）U/L、（81.4±21.2）U/L比（98.5±34.7）U/L、（55.9±14.7）U/L比（67.3±17.6）U/L］，差异均有统计学意义（t=2.67、2.84、2.06、2.44，均P<0.05）；试验组cTnI在T1、T2、T3和T4时点均明显低于对照组［（7.4±3.1）µg/L比（9.9±2.3）µg/L、（6.0±2.2）µg/L比（8.9±4.0）µg/L、（6.4±3.3）µg/L比（8.6±4.1）µg/L、（6.8±2.6）µg/L比（8.9±3.4）µg/L］，差异均有统计学意义（t=3.17、3.11、2.05、2.40，均P<0.05）；试验组术后T4时点的ATP、ADP、AMP、CP水平均明显高于对照组，差异均有统计学意义（均P<0.05）。试验组术后T4时点的氧合指数高于对照组［（331.6±43.3）比（273.7±33.3）］，差异有统计学意义（t=2.90，P<0.01）。结论　含磷酸肌酸钠的高钾冷液晶停跳液用于体外循环下行手术治疗的房室间隔缺损修补术的患儿，可减轻心肌缺血再灌注损伤，维持心肌缺血时的能量供应和术后肺的氧合指数，具有很好的心肺保护作用，有利于患儿术后康复。

关键词: 小儿, 房室间隔缺损, 体外循环, 磷酸肌酸钠, 心肌, 能量代谢, 氧合指数

Abstract: Objective　To investigate the effect of cold crystal cardioplegic solution and sodium creatine phosphate on myocardial energy metabolism and cardiopulmonary function in children taking atrio-ventricular septal defect repair under cardiopulmonary bypass. Methods　This was a prospective random control study. Forty-eight children with atrio-ventricular septal defect surgically treated under cardiopulmonary bypass in Foshan Hospital Affiliated to Southern Medical University were selected, and were divided into an experimental group and a control group by the random number table method, with 24 cases in each group. There were 14 males and 10 females in the control group, and they were (7.2±3.4) years old and weighed (20.2±5.8) kg. There were 16 males and 8 females in the experimental group, and they were (7.0±3.4) years old pand, weighed (20.4±9.5) kg. The conventional cold crystal cardioplegic solution with high potassium was used in the control group, and the cold crystal cardioplegic solution with sodium creatine phosphate in 10 mmol/L concentration was used in the experimental group. The repair of atrio-ventricular septal defect under cardiopulmonary bypass was performed in both groups. The cardiopulmonary bypass times, aortic cross-clamp times, cardiopulmonary bypass time assisting times, incidences of automatically restoring of heart beat, cases of administration of dopamine and adrenaline, and postoperative ventilator support times in both groups were observed and recorded. The serum levels of creatine kinase isoenzyme (CK-MB) and cardiac troponin I (cTnI) were detected by the immuno-fluorescence method before cardiopulmonary bypass (T0), 5 (T1) and 30 min (T2) after aortic clamp release, and 4 (T3) and 24 hours (T4) after cardiopulmonary bypass. The venous blood sample was taken before and 1 day after the operation; the contents of adenosine triphosphate (ATP), adenosine diphosphate (ADP), adenosine monophosphate (AMP), and creatine phosphate (CP) were determined by high performance liquid chromatography. t test, chi-square test, and one-way ANOVA were used for statistical analysis. Results　There were no statistical differences in the cardiopulmonary bypass time, aortic cross-clam time, cardiopulmonary bypass assisting time, and incidence of automatically restoring of heart beat between the experimental group and the control group [(63.4±13.4) h vs. (67.1±19.8) h, (30.9±11.6) h vs. (32.1±14.5) h, (18.3±10.1) h vs. (22.3±9.3) h, and 100.0% (24/24) vs. 100.0% (24/24); all P>0.05]. The postoperative ventilator support time in the experimental group was shorter than that in the control group [(6.7±2.3) h vs. (7.9±1.4) h], with a statistical difference (t=2.18, P=0.03). The levels of CK-MB at T1, T2, T3, and T4 in the experimental group were significantly lower than those in the control group [(22.4±5.3) U/L vs. (27.5±7.7) U/L, (68.5±11.9) U/L vs. (80.4±16.7) U/L, (81.4±21.2) U/L vs. (98.5±34.7) U/L, and (55.9±14.7) U/L vs. (67.3±17.6) U/L], with statistical differences (t=2.67, 2.84, 2.06, and 2.44; all P<0.05). The levels of cTnI at T1, T2, T3, and T4 in the experimental group were significantly lower than those in the control group [(7.40±3.10) µg/L vs. (9.90±2.30) µg/L, (6.00±2.20) µg/L vs. (8.90±4.00) µg/L, (6.40±3.30) µg/L vs. (8.60±4.10) µg/L, and (6.80±2.60) µg/L vs. (8.90±3.40) µg/L], with statistical differences (t=3.17, 3.11, 2.05, 2.40; all P<0.05). The levels of ATP, ADP, AMP, and CP at T4 in the experimental group were significantly higher than those in the control group, with statistical differences (all P<0.05). The oxygenation index at T4 in the experimental group was higher than that in the control group [(331.6±43.3) vs. (273.7±33.3)], with a statistical difference (t=2.90, P<0.01). Conclusion　The cold crystal cardioplegic solution with high concentration of potassium containing sodium creatine phosphate can alleviate myocardial ischemia-reperfusion injury in children taking atrio-ventricular septal defect repair under cardiopulmonary bypass and maintain their heart energy supply during myocardial ischemia and the lung oxygenation index after operation, has good cardiopulmonary protection, and is beneficial for their postoperative rehabilitation.

Key words: Children, Atrio-ventricular septal defect, Cardiopulmonary bypass, Sodium creatine phosphate, Myocardium, Energy metabolism, Oxygenation index

张武, 李贻霞, 吴丽灵, 蒙丽婵, 霍保善, 詹锋, 杨凯, 胡旭东. 磷酸肌酸钠对体外循环下房室间隔缺损修补术患儿心肌能量代谢和心肺功能的影响[J]. 国际医药卫生导报, 2022, 28(5): 656-662.

Zhang Wu, Li Yixia, Wu Liling, Meng Lichan, Huo Baoshan, Zhan Feng, Yang Kai, Hu Xudong. Effect of sodium creatine phosphate on myocardial energy metabolism and cardiopulmonary function in children taking atrio-ventricular septal defect repair under cardiopulmonary bypass[J]. International Medicine and Health Guidance News, 2022, 28(5): 656-662.

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磷酸肌酸钠对体外循环下房室间隔缺损修补术患儿心肌能量代谢和心肺功能的影响

Effect of sodium creatine phosphate on myocardial energy metabolism and cardiopulmonary function in children taking atrio-ventricular septal defect repair under cardiopulmonary bypass

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