参麦注射液对心脏瓣膜置换术患者血管内皮活性因子水平的影响  

Effect and significance of Shenmai injection on value of vascular endothelial active facters of heart valve replacement patients

作　　者：林丽娜[1] 王良荣[1] 陈菲菲[1] 胡明伦[1] 缪剑霞[1] 王俊[1] 

机构地区：[1]温州医学院附属第一医院,浙江温州325000

出　　处：《中国中药杂志》2009年第9期1155-1158,共4页China Journal of Chinese Materia Medica

基　　金：浙江省中医药管理局科研基金项目(2008CA071)

摘　　要：目的:探讨参麦注射液对体外循环(CPB)心脏瓣膜置换术患者血管内皮活性因子一氧化氮(NO)和内皮素(ET)水平的影响及其肺功能的保护效果。方法:选择CPB下行心脏瓣膜置换术患者30例,按单盲法随机分为对照组(C组)和参麦注射液组(SM组),每组15例。SM组于CPB转机前将参麦注射液0.6 mL.kg-1加入250 mL生理盐水静脉滴注完毕,C组在相同时间内静脉滴注等量的生理盐水。动态观察2组患者全身麻醉诱导前(T0),体外循环(CPB)停机后0.5 h(T1),2 h(T2),6 h(T3),24 h(T4)5个时点的肺泡-动脉血氧分压差[P(A-a)DO2]、呼吸指数(R I)、血浆一氧化氮(NO)和内皮素-1(ET-1)浓度的变化,同时记录CPB时间和主动脉阻断时间。结果:2组患者CPB后ET-1,P(A-a)DO2,R I值较T0明显升高(P<0.01或P<0.05),但SM组上升程度明显低于C组(P<0.01或P<0.05);两组血NO浓度则在CPB后明显下降(P<0.05),但SM组下降幅度明显小于C组(P<0.01或P<0.05);结论:ET-1和NO参与体外循环后的肺损伤过程,参麦注射液可通过提高NO、降低ET-1水平,从而减轻体外循环后肺损伤和通气功能障碍,保护并改善术后肺功能。Objective ： To observe the effect of Shenmai injection on the value of vascular vndothelial vctive facters nitric oxide （ NO）, endothelin-1 （ ET-1 ） of patients undergoing heart valve rveplacement and cardiac pulmonary bypass （CPB）. Method ： Thirty patients of cardiac valve replacement undergoing open heart surgery under cardiopulmonary bypass （CPB） were randomized single-blind method divided into Shenmai injection group （SM） and contral group （C） with 15 cases each. shenmai injection group （SM） were injected Shenmai injection 0. 6 mL. kg^-l added to physiological saline 250 mL after anaesthesia before CPB, the control control group were injected only physiological saline 250 mL at the same time. Blood samples were taken before induction of anesthesia and at 0. 5, 2, 6, 24 hours after terminating CPB. To calculate P（A-a） DO2 and respiratory indexs （RI） by blood gas analysis, nitric oxide （NO） and endothelin-1 （ET-1） ET-1 were measured. At the same time, the time of CPB and artery blockage were recorded. Result： There was no statistical significance before operation between 2 groups to every blood index. After CPB, P（A-a） DO2 , RI and ET-lwas higher than pre-operation after CPB （ P 〈 0. 05 ）. But P（A-a） DO2 , RI and ET-1 of Shenmai group were lower than control group evidently at every point after CPB （P 〈0. 05 or P 〈0. 01 ）. The concentrations of NO were reduced obveiously after CPB （P 〈0.05）, but in shenmai group, the range of descent was lower than control group （ P 〈 0. 01 or P 〈 0. 05 ）. Conclusion ： The concentrations of NO and ET-1 is connected with the lung injury after CPB. Through rise the level of NO and reduce the level of ET-1, Shenmai injection can alleviate the lung injury in some degree after CPB and improve pulmonary oxygenation function.

关 键 词：参麦注射液 体外循环 一氧化氮 内皮素-1 

分 类 号：R26[医药卫生—中医外科学]