参附注射液对心脏直视术中心肌缺血／再灌注损伤的保护作用  

Effect of Shenfu injection on myocardial protection in patients undergoing cardiac surgery with cardiopulmonary bypass

作　　者：万彩红[1] 董培青[1] 杨璟[1] 何美玲[1] 柳薇[1] 

机构地区：[1]首都医科大学附属北京安贞医院体外循环科,100029

出　　处：《中华胸心血管外科杂志》2008年第6期389-392,共4页Chinese Journal of Thoracic and Cardiovascular Surgery

基　　金：卫生部999中药注射液科研基金项目资助（200307）

摘　　要：目的探讨参附注射液在体外循环（CPB）心脏直视术中的心肌保护作用。方法60例择期心脏手术病人随机分成参附组和对照组，每组30例。参附组将2ml／kg的参附注射液加入体外循环预充液中。分别在术前、升主动脉阻断30min、升主动脉开放再灌注10min时测定血清磷酸肌酸激酶同工酶（CK-MB）、磷酸肌酸激酶（CK）和乳酸脱氢酶（LDH）含量。测定心肌缺血30min、缺血再灌注10min时血浆肌钙蛋白cTnI的浓度。应用透射电镜观察心肌细胞超微结构改变，并对线粒体进行体视学分析。结果两组病人心肌酶谱、cTnI含量在升主动脉阻断开放后显著升高。缺血30min时参附组cTnI为（1．19±1．18）ng/ml，对照组cTnI为（2．49±1．68）ng／ml；心肌再灌注10min时参附组cTnI为（4．58±2．22）mg/ml，对照组（9．17±7．43）ng／ml，两组比较，各时点差异均有统计学意义（P〈0．05）。超微结构及体视学分析都显示参附注射液能明显减轻心肌细胞、组织结构及线粒体的损伤程度。结论参附注射液对心肌有一定保护作用，在一定程度上能减轻体外循环期间的心肌缺血，再灌注损伤。Objective To investigate the protective effect of shenfu injection on myocardium in patients undergoing open cardiac surgery with cardiopulmonary bypass （CPB）. Methods Sixty patients scheduled for selective cardiac surgery were randomly divided into Shenfu group and control group with 30 cases respectively. In Shenfu group, 2ml/kg Shenfu injection was added into membrane oxygenator before CPB. Blood samples were collected to measure the concentration of sertun CK, CK-MB, LDH before operation, 30min after cross-clamp of ascending aorta and 10 min after release of cross-clamp. The levers of serum cTnI were measured 30 min after cross-clamp of ascending aorta and lOmin after release of cross-clamp. The morphologic studies were made with a light microscope and an electron microscope. A mitochondrial stereology analysis was done. Remllts There were no differences on the activities of serum CK, CK-MB, LDH between two groups. The level of cTnI increased obviously after release of eros.s-damp, but Level of cTnI in Shenfu group was much lower than that in control group （ P 〈 0.05）. The murphologic and ultrastructual measurements indicated milder damages eccurred in Shenfu group. Conclusion Shenfu injection may reduce myocardial ischemia/reperfusion injury in pa- tients undergoing cardiopulmonary bypass.

关 键 词：心肌再灌注损伤 心肺转流术 心肌 参附注射液 

分 类 号：R686[医药卫生—骨科学]