环磷酸腺苷葡胺对冠心病患者行非心脏手术心肌保护作用的临床研究【摘要】目的观察环磷酸腺苷葡胺对冠心病患者行非心脏手术心肌的保护作用。方法选择90例行上腹部手术的冠心病病人，随即分为A、B、C三组，A组：麻醉诱导前20minMcAMP2mg/kg静滴；B组：麻醉诱导前10minMcAMP静注20mg，随后2mg/kg加入100ml生理盐水中持续缓慢静滴至术毕；C组：麻醉诱导前10min静注等量的生理盐液，然后100ml生理盐液持续静滴。观察麻醉诱导前、术后8h、术后24h血浆CKMB、IL6、TNFα、SOD、MAD的变化。结果A、B、C三组与T1相比CKMB、TNFα、IL6、MDA血浆浓度均有显着增高，血浆SOD浓度显着降低，A、B组与C组相比变化幅度具有显着统计学差异。结论McAMP在冠心病患者行非心脏手术时对心肌有保护作用。【关键词】环磷酸腺苷葡胺冠心病非心脏手术Abstract：ObjectiveToinvestigatethemyocardialprotectionofmeglumingcyclicadenylate(McAMP)duringnon-cardiacsurgeryinthepatientswithcoronaryarterydisease.MethodsNintypatientsscheduledforelectiveabdominaloperationswererandomlyallocatedintoGroupA,BandC.InGroupA(n=30),2mg/kgofMcAMPwasinfused20minutesearlierbeforeinductionofanesthesia.InGroupB(n=30),20mgofMcAMPwasinfused10minutesearlierbeforeinductionofanesthesia,and2mg/kgofMcAMPwascontinuouslyinfusedduringoperation.InGroupC(n=30),100mlofisotonicsalinesolutionwascontinuouslyinfusedduringoperation.Arterialbloodsampleswerecollectedimmediatelybeforeinductionofanesthesia,and8and24hoursafteroperation.Someparameters,suchascreatinekinase(CK)MB,tumornecrosisfactor(TNF)α,interleukin(IL)6,superoxidedismutase(SOD)andmalondialdehyde(MDA),weremeasured.ResultsThelevelsofCKMB,TNFα,IL6andMDAincreasedinallthethreegroups,andtheactivityofSODdecreasedinallthethreegroups(),buttherewassignificantdifferenceinfluctuationbetweenGroupAorBandGroupC().ConclusionMcAMPcanprotectcardiacmuscleduringnoncardiacsurgeryinthepatientswithcoronaryarterydisease.Keywords：meglumingcyclicadenylate;coronaryarterydisease;noncardiacsurgery如何减少心肌缺血患者在围术期出现急性心肌缺血甚至心肌梗死的发生，是临床麻醉研究的重点内容之一。有心肌缺血背景的手术病人存在较大的麻醉危险，即使经过充分术前准备的病人，仍有%的几率出现心梗或严重的心律失常。采用药物增强心肌对缺血的耐受力具有重要意义。环磷酸腺苷具有保护心肌细胞、增强心肌收缩力、增加心输出量的作用，常用于纠正难治性的心力衰竭、充血性心力衰竭等。其作用与直接扩张冠状动脉从而减轻心肌缺血有关。本研究旨在探讨环磷酸腺苷葡胺在非心脏手术时对心肌缺血和再灌注损伤的心肌保护作用。MyocardialProtectionofMeglumingCyclicAdenylateduringNoncardiacSurgeryinPatientswithCoronaryArteryDiseaseMaHuilan,GengZhilong,LiTao,MaLong,WangGongxiao,TangYiDepartmentofAnesthesiology,Lanz