【作者】 朴哲；

【导师】 李星云；

【作者基本信息】 延边大学 ， 外科学， 2014， 硕士

【摘要】 目的：探左西孟旦(Levosimendan Injection, LEV)在体外循环下二尖瓣置换术中心肌缺血-再灌注损伤的保护作用。方法：选取延边大学附属医院心血管外科2011年11月至2014年3月风湿性心脏瓣膜病患者28例,随机分为对照组(n=14))和LEV组(n=14),对照组患者术前术中给予常规心肌营养,左西孟旦组患者在麻醉诱导前左西孟旦注射液0.2ug/kg/min持续24h静脉给药,分别于术前(T1)、术毕(T2)、术后24h(T3)、术后7d(T4)抽取患者静脉血,检测血浆乳酸脱氢酶(lactate dehydrogenase, LDH),肌酸激酶(Creatine Kinase, CK),肌酸激酶同工酶(Creatine Kinase-MB, CK-MB),心肌肌钙蛋白I (Cardiac Troponin I, cTnI),并记录患者术前及术后7d左室射血分数(left ventricular ejection fraction, LVEF)。结果：与对照组相比,给药组T2、T3、T4血浆LDH, cTnI浓度明显低于T1(P<0.01,P<0.05),T2、T3血浆CK、CK-MB浓度均明显低于T1(P<0.01,P<0.05),T4无明显统计学差异(P>0.05)。对照组术前与术后相比LVEF无明显差异(P>0.05),给药组LVEF较术前升高(P<0.05)。结论：1.左西孟旦注射液对二尖瓣置换术后患者具有降低心肌酶学指标和cTnI水平,有效地提高左室射血分数作用。2.左西孟旦注射液可减轻心脏瓣膜置换术中的心肌缺血-再灌注损伤,对心肌具有保护性作用。更多还原

【Abstract】 Objective:To Observe of levosimendan injection effects on myocardial enzymes and left ventricular ejection fraction in patients undergoing cardiac valve replacement, exploring its cardioprotective role in the open-heart surgery with cardiopulmonary bypass when the heart suffered myocardial ischemia-reperfusion injury. Providing clinical evidence for postoperative improvement of cardiac functionon.Methods:Collecting28cases with rheumatic heart valve disease from November2011to March2014in Cardiovascular Surgery department of Yanbian Hospital. The patients were randomly divided into control group (N) and the levosimendan group (L),16cases in each group. the patients of group N were routinely given preoperative myocardial nutrition, group L were given levosimendan injection by0.2ug/kg/min24h continued intravenous administration before induction of anesthesia. Extraction of venous blood in patients with preoperation (T1), postoperation (T2),24h after sugery(T3),7d after surgery(T4), deteted plasma lactate dehydrogenase (LDH), isoenzyme of creatine phosphate (CK-MB), cardiac troponin Ⅰ (cTn Ⅰ), and record left ventricular ejection fraction of preoperation and7d after surgery.Result:Compared with control group, concentrations of serum LDH, cTnI in T1, T2, T3were significantly lower than T1in the drug group (P<0.01, P<0.05), concentrations of serum CK, CK-MB in T2, T3were significantly lower than T1(P <0.01, P<0.05), There is no significantly statistical difference in T4(P>0.05). No obvious difference of LVEF from preoperative to postoperative in the control group(P>0.05), LVEF was elevated compared with preoperative in dosage group (P <0.05).Conclusion:1Levosimendan injection on patients after heart valve replacement can reduce the level of myocardial enzymology indexes and troponin I, effectively improve the left ventricular ejection fraction.2levosimendan injection can reduce myocardial ischemia-reperfusion injury in heart valve replacement surgery, It has protective effect on myocardium.更多还原