【作者】 胡根源；

【导师】 周汝元；

【作者基本信息】 安徽医科大学 ， 外科学， 2004， 硕士

【摘要】 目的：通过川芎嗪预处理对风心瓣膜病患者围术期血浆中肌钙蛋白Ⅰ变化影响的研究，探讨川芎嗪预处理对风心瓣膜病患者心脏直视手术心肌细胞的保护作用。方法：随机选取2003年7月至2004年4月安徽医科大学第一附属医院心血管外科手术治疗风心瓣膜病40例。随机分为川芎嗪预处理组(A组，n=20)及对照组(B组，n=20)。川芎嗪预处理组手术前1周开始应用盐酸川芎嗪注射液4mg／kg／d(常州制药厂，40mg／支，生产批号0204002)至术前一天，两组分别于用药前、主动脉阻断后30分钟、主动脉开放后30分钟、术后24h、术后48h，术后72h和术后150h抽取静脉血，根据需要行抗凝、离心，分离出血浆，测定血浆中心肌肌钙蛋白Ⅰ(cTnI)、磷酸肌酸激酶(CK)、磷酸肌酸激酶同工酶(CK-MB)、乳酸脱氢酶(LDH)。记录心脏自动复跳率和术后正性肌力药物使用、并发症及愈后情况。结果：1．对照组各时点血浆心肌肌钙蛋白I(cTnI)、磷酸肌酸激酶(CK)、磷酸肌酸激酶同工酶(CK-MB)、乳酸脱氢酶(LDH)含量明显高于实验组，差异均有显著性(附表)。2．心肌肌钙蛋白Ⅰ的敏感性优于心肌酶谱。3．实验组心脏自动复跳率80％，对照组心脏自动复跳率65％，差异有显著性(P＜0.01)。4．实验组肾上腺素使用比率5％；对照组肾上腺素使用比率20％，LCOS 2例，差异有显著性(P＜0.05)。结论：1．风湿性心病患者围术期，血浆中心肌肌钙蛋白Ⅰ(cTnI)、磷酸肌酸激酶(CK)、磷酸肌酸激酶同工酶(CK-MB)、乳酸脱氢酶(LDH)均发生变化，但心肌肌钙蛋白Ⅰ的变化更敏感。这与其它文献报告相一致。2．川芎嗪预处理明显影响血浆中心肌肌钙蛋白Ⅰ和磷酸肌酸激酶(CK)、磷酸肌酸激酶安徽医科大学硕士学位论文同工酶(CK一MB)、乳酸脱氢酶(LDH)的变化，心肌肌钙蛋白工的变化更敏感;3川芍嗓预处理能减轻心肌缺血再灌注损伤。更多还原

【Abstract】 Objective:.This articles studys the change of the release of cardiac troponin I during the heart valves replaced after Tetramethylpyrazine preconditioning, To approach Tetramethylpyrazine’s preserving the myocardiumMethod: from 2003 year 7 month to 2004 year 4 month 40 patients finally diagnosed as rheumaetic heart disease were randomly divided into the Tetramethylpyrazine group (A group,n=20) and the control group (B group,n=20).The patients of A group were injected with Tetramethylpyrazine(4mg/kg) before operation.the Venous blood samples between two grounps were taken at the following times before using Tetramethylpyrazine, thirties minutes after the aorta blocked, thirties minutes after aorta opened,24 hours 48 hours 72 hours and 150 hours after operation. We measure the concentrations of cTnI,CK,CK-MB and LDH.record the rate of automatical heart ambi-beat. and inotropic agent use after operation complication and information of curingResults: 1.every time point content of cTnI,CK,CK-MB and LDH in the control group was obviously superer than that in the Tetramethylpyrazine group (P<0.01 < 0.05, seen in attached table2) . The sensitivity of cTnI was superer than that of the myocard zymogram 3. the rate of automatical heart ambi-beat is eighty percent in the Tetramethylpyrazine group,but sixty-five percent in the control group,The disparity oftwo groups is significant (P<0.01 0.05) 4.The rate of adrenalin use is five percent in the Tetramethylpyrazine group,but twenty percent in the control group.one was dead after operation in the Tetramethylpyrazine group,three were dead in the control group and two LCOSes happentConclusion: : 1.Plasma cTnI and plasma CK ,CK-MBand LDH levels change obviously. But cTnI is more sensitive these are coincident with other dicuments; 2. Tetramethylpyrazine preconditioning can affect plasma cTnI ,CK ,CK-MBand LDH levels obviousely. But cTnI is more sensitive-, 3. Tetramethylpyrazine can mitigate ischemical reperfusion injury of myocardial cell更多还原