三七总皂甙预处理对体外循环胃肠缺血的抗损伤作用  

The Protective Role of Pre-treat with Total Saponins of Pannx Notoginsenoside(PNS)to Gastric Mucosa Ischemia During Cardiopulmonary Bypass

作　　者：马莉[1] 陈燕[1] 何建超[2] 莫治强[1] 罗用宇[1] 

机构地区：[1]昆明医学院第一附属医院麻醉科 [2]昆明医学院心外科,云南昆明650032

出　　处：《昆明医学院学报》2008年第2期77-81,共5页Journal of Kunming Medical College

基　　金：云南省卫生厅基金资助项目(99;005)

摘　　要：目的观察三七总皂甙(血塞通注射液)预处理对体外循环(CPB)患者胃肠循环和全身炎症反应的影响.方法将67例先心病行心内直视手术的患者随机分为对照组(34例)、三七总皂甙组(33例).三七总皂甙组在术前1周每天静脉滴注三七总皂甙注射液5 mg/kg预处理至手术当天.术中持续监测心电图(ECG)、动脉血氧饱和度(SPO2)、中心静脉压(CVP)、心率(HR)、血压(BP)、呼吸频率(RR)、收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)、呼末二氧化碳分压(PETCO2),同时监测尿量、鼻咽温和肛温.在气管插管后经鼻放置胃管,分别在转机前(T0)、转机后30 min(T1)、停机后30 min(T2)和术后最初24 h(T3)抽取胃液,测pH值(即PcCO2),同时抽取动脉血测[HCO3-],并用Handerson-Hasselbalch方程计算胃粘膜pH值(即pHi);分别抽取静脉血采用双抗体夹心ABC-ELISA法检测E-选择素(E-Selection)及采用酶联免疫吸附法检测TNF-a和IL-6.结果所有病人胃粘膜pH值(pHi)在转机后不同时段均低于转机前(P<0.05),但三七总皂甙组下降的程度少于对照组(P<0.05);两组病人在转机后30 min(T0)、停机后30 min(T1)和术后最初24 h(T3)血清E-选择素、TNF-a和IL-6较转机前30 min(T0)都升高(P<0.05),但在T1、T2、T3各时间点E-选择素(E-Selection)、TNF-a和IL-6水平三七总皂甙组均低于对照组(P<0.05).结论预防性滴注三七总皂甙注射液可有效改善胃肠粘膜的血液灌注和氧供,从而减轻体外循环(CPB)病人胃肠不良反应及全身炎症反应.Objective To investigate the effects of pre-treating with Panax notoginsenoside （PNS） on the gastric mucosa circulate and systemic inflammatory response of CRB patients. Methods 67 congenital heart disease patients under open heart operation were randomly selected and divided into the. group of dealed with normal way （control group, n = 34） and the group of pre - treated with Panax notoginsenoside （PNS） （PNS group, n = 34）. Before one week of the operation, patients in control group were intravenously infused 5% glucose solution 250 mL, patients in PNS group were intravenously infused PNS 5 mg/kg solved in 5% glucose solution 250 mL. During operation we continuously monitored ECG, SPO2, CVP, HR, BP, MAP, RR, SBP, DBP and PETCO2, and tested the volume of urine and the temperature of skin and nasophrynx. Placed tube in venter with laryngoscope guide after intubated, drawing out the volume of in venter, closing tube after infused physiological saline 30 mL into stomach, stabling 30 min. Partly taking out 2 mL the gastric juice at 30 min （T0） before CPB, 30 min （T1） after intermission CPB , 30 min （T2） after completion of CPB and 24 h （T3） after the surgery respectively to testing pH, obtaining the blood of artery to testing （HCO3^-） , and calculating intramucosa pH （pHi） using the equation of Handerson-Hasselbalch. Taking the blood of vein to measuring E-Selection with the ways of ABC-ELISA and TNF-a and IL-6 by means of ELISA. Results Compared with the pre- CPB, the intramucosa pH （pHi） of all patients was lower （P 〈 0.05） , but the decrease level of the group of PNS was lower than the group of control （P 〈 0.05）. The E-Selection, TNF-a and IL-6 at 30 min （TI） after intermission CPB, 30 min （T2） completion of CPB and 24 h （T3） after surgery respectively of two groups compared with pre-CPB increased （P 〈 0.05）, but the increase degree of the group of PNS was lower than the group of control in T1, T2, T3 （P 〈 0.05）. Conclusion Pre-treatin

关 键 词：三七总皂甙 体外循环 全身炎症反应 胃粘膜PH 

分 类 号：R614[医药卫生—麻醉学]