林辉+王松清+林慧卿

[摘要] 目的 探讨磷酸肌酸钠在老年患者髋关节置换手术中对心肌保护作用。 方法 方便该研究选取2015年1—12月在福州市第二医院收治的64例术前心电图检查有心肌缺血的髋关节置换手术患者按照数字表法随机分为研究组和对照组，其中对照组患者在入室后点滴生理盐水，而研究组则点滴磷酸肌酸钠，比较两组患者麻醉时最大ST段下移幅度、血液中CK-MB、cTnI水平。 结果 在切皮后1 h[（1.52±0.57）mm]和术毕[（1.78±0.66）mm]，研究组的最大ST段下移幅度較对照组明显减低，差异有统计学意义（P<0.05）。两组患者切皮后1 h、术毕的CK-MB、cTnI水平均较麻醉后明显升高；而研究组与对照组相比较在切皮后1 h[（39.00±7.00）U/L， （0.62±0.54）ng/mL]、术毕[（60.00±5.00）U/L， （0.72±0.64）ng/mL]明显回落，差异有统计学意义（P<0.05）。结论 在麻醉前，给予伴有心肌缺血的老年髋关节置换术患者磷酸肌酸钠可以减低最大ST段下移幅度，保护心肌功能，有助于提高手术安全，值得临床推广使用。

[关键词] 磷酸肌酸钠；老年；髋关节置换术；心肌保护

[中图分类号] R42.2 [文献标识码] A [文章编号] 1674-0742（2017）02（a）-0093-03

[Abstract] Objective To discuss the protective effect of creatine phosphate sodium on the musculus cardiacus in the hip replacement of senile patients. Methods Convenient selection 64 cases of hip replacement patients with ischemia myocardial by the preoperative electrocardiographic examination admitted and treated in our hospital from January to December 2015 were randomly divided into two groups， the control group were injected with the normal saline， while the research group were injected with creatine phosphate， and the maximum ST segment depression range， CK-MB and cTnI levels in blood of the two groups were compared. Results Affer 1 h（1.52±0.57）mm and postoperatinva （1.78±0.66）mm The maximum ST segment depression at 1 h after skin incision and at the end of operation obviously decreased compared with those in the control group， and the difference had statistical significance（P<0.05）， and the CK-MB and cTnI levels in blood of the two groups obviously increased compared with those after anaesthesia， and the CK-MB and cTnI levels in the research group obviously declined compared with those in the control group at 1 h after skin incision and at the end of operation[（39.00±7.00）U/L， （0.62±0.54）ng/mL vs （60.00±5.00）U/L， （0.72±0.64）ng/mL]， and the differences had statistical significance（P<0.05）. Conclusion Before anaesthesia， the creatine phosphate sodium for senile hip replacement patients with musculus cardiacus can reduce the maximum ST segment depression range， protect the musculus cardiacus function and help to improve the operation safety， which is worth clinical promotion and application.

[Key words] Creatine phosphate sodium； Senile； Hip replacement； Musculus cardiacus protection

为了探讨磷酸肌酸钠在老年患者髋关节置换手术中对心肌保护作用研究，该研究于2015年1—12月将收治的64例术前心电图检查有心肌缺血的髋关节置换手术患者按照数字表法随机分为研究组和对照组，其中对照组患者在入室后点滴生理盐水，而研究组则点滴磷酸肌酸钠，比较两组患者麻醉时最大ST段下移幅度、血液中CK-MB、cTnI水平，取得了良好的临床效果，现报道如下。

1 资料与方法

1.1 一般资料

方便选择在该院经术前心电图检查存在心肌缺血的髋关节置换术患者64例，其中男性30例，女性34例；年龄61～82岁，平均年龄（72.92±8.27）岁；ASA分级：II级37例，III级27例。入选的患者均对该次研究知情同意，且获得医院伦理委员会批准；所有患者均无蛛网膜下腔阻滞禁忌症；排除对酰胺类局麻药物过敏者。按照数字表法将64例患者随机分为研究组和对照组，每组32例，对照组中男性16例，女性16例；……