Efficiency of L-arginine enriched cardioplegia and non-cardioplegic reperfusion in ischemic hearts.
Efficiency of L-arginine enriched cardioplegia and non-cardioplegic reperfusion in ischemic hearts.
复制标题
富含 L-精氨酸的心脏停跳液和非心脏停跳液在缺血性心脏中的效率。
DOI：
10.1016/j.ijcard.2003.08.015
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发表时间：
2004
影响因子：
3.5
通讯作者：
U. Ozyurda
中科院分区：
文献类型：
--
作者：
U. Kızıltepe;B. Tunctan;Z. Eyileten;M. Şırlak;Mehmet Arikbuku;Refik Taşoz;A. Uysalel;U. Ozyurda
内皮功能障碍与一氧化氮（NO）水平降低与再灌注损伤有关。尽管体外研究表明左旋精氨酸可以减轻再灌注损伤，但临床研究非常有限。方法将40例接受冠状动脉旁路移植术的急性心肌缺血患者随机分为研究组和对照组。实验组在停搏液中加入左旋精氨酸。输注含8 mmol/l l l-精氨酸的非心脏停搏温血溶液用于控制性再灌注。对照组患者接受相同的方案，不含l-精氨酸。测定心肌氧分压、乳酸、亚硝酸盐和丙二醛含量，计算CK-MB/CPK比值和血流动力学参数。结果研究组无死亡，对照组死亡1例。总体而言，研究组和对照组的亚硝酸盐（P=0.01）和乳酸盐提取物（P=0.04）分别较高。研究组心肌氧摄取率高于对照组，丙二醛提取率低于对照组。术后6小时CK-MB/CPK比值明显低于对照组。90%的研究组患者自发恢复窦性心律，而80%的对照组患者需要除颤（P<0.0001）。除了显着更好的血流动力学，围手术期心肌梗死的发生率较低（P=0.037），重症监护室（P=0.009）和住院时间（0.014）在Studygroup.ConclusionsUse的L-精氨酸保护急性缺血心肌似乎是一种安全的技术。补充L-精氨酸可增加NO水平，减轻O2自由基介导的心肌损伤。富含l-精氨酸的非心脏停搏血控制性再灌注可能是减轻缺血/再灌注损伤的一种新的治疗手段。
ObjectiveEndothelial dysfunction with decreased nitric oxide (NO) levels has been implicated on reperfusion injury. Although l-arginine has been shown to diminish reperfusion injury in in vitro studies, clinical studies were very limited.MethodsForty patients with acute myocardial ischemia undergoing CABG were randomized to a study and a control group. l-Arginine was added to cardioplegia solutions in study group. A non-cardioplegic warm blood solution with 8 mmol/l l-arginine infused for controlled reperfusion. Control patients received same protocol without l-arginine. Myocardial O2, lactate, nitrite and malondialdehyde extractions were measured in addition to calculation of CK-MB/CPK ratio and hemodynamic data.ResultsWhile there was no mortality in study group, one patient in control group died. Overall and nitrite (P=0.01) and lactate extractions (P=0.04) was higher in study and control groups, respectively. Myocardial O2uptake was higher and malondialdehyde extraction was lower in study group. CK-MB/CPK ratio at postoperative sixth hour was also significantly lower in study group. Ninety percent of the study group had spontaneous return of the sinus rhythm, while 80% of the control patients required defibrillation (P<0.0001). In addition to significantly better hemodynamics, perioperative myocardial infarction incidence was lower (P=0.037), the length of intensive care unit (P=0.009) and hospital (0.014) stays were shorter in study group.ConclusionsUse of l-arginine for protection of acutely ischemic myocardium appears to be a safe technique. l-Arginine supplementation increased NO levels and attenuated free O2radical mediated myocardial injury. Controlled reperfusion with l-arginine enriched non-cardioplegic blood could be a new therapeutic entity to diminish ischemia/reperfusion injury.