复方丹参对心内直视手术心肌缺血再灌注后血清过氧化脂质及前列环素变化的影响  

Effects of salvia miltiorrhazae compound on serum lipid peroxidation and PGI_2 during oppen heart surgery

作　　者：吴志[1] 夏正远[1] 黄海波[2] 顾家珍[2] 

机构地区：[1]中山医科大学光华口腔医院麻醉科,广州市510060 [2]湖北医科大学附属第一医院麻醉科

出　　处：《临床麻醉学杂志》2002年第5期242-244,共3页Journal of Clinical Anesthesiology

摘　　要：目的　观察复方丹参对心肺转流 (CPB)心内直视手术心肌缺血再灌注后血清过氧化脂质及前列环素 (PGI2 )变化的影响。方法　 2 0例先天性室间隔缺损或房间隔缺损患者麻醉后随机分为对照组 (Ⅰ组 ,n =10 )及丹参组 (Ⅱ组 ,n =10 )。Ⅱ组患者于手术开始前及复温后心脏复跳前分别静注复方丹参 2 0 0mg/kg ,Ⅰ组给予等容量复方乳酸钠。于手术开始前 (T0 )、心肌缺血前 (T1 )、心肌缺血 30分钟 (T2 )、再灌注后 10分钟 (T3 )和 30分钟 (T4)、停CPB 30分钟 (T5)及再灌注后 2 4小时(T6)抽中心静脉血测丙二醛 (MDA)及前列环素。结果　Ⅰ组血清MDA于CPB后逐渐升高 ,再灌注后迅速增加 ,于T4、T5、T6显著高于其T2 时值 (P <0 0 5或P <0 0 1)。Ⅱ组再灌注后未出现显著的血清MDA升高 ,且缺血及再灌注后各时期Ⅱ组MDA均显著低于Ⅰ组 (P <0 0 5 )。CPB后两组前列环素均显著上升 ,而再灌注后迅速下降 ,但T2 及T6时Ⅱ组前列环素均显著低于Ⅰ组 (P <0 0 1,P <0 0 5 )。术后Ⅱ组心功能的恢复优于Ⅰ组。结论　复方丹参能显著降低心脏缺血及再灌注期脂质过氧化程度 ,抑制缺血期前列环素的急剧增加 。Objective To observe the effect of salvia miltiorrhazae compound (SMC) on serum MDA and PGI 2 during open heart surgery under CPB.Method 20 congenital VSD or ASD patients were divided randomly into control group(group Ⅰ,n=10) and SMC group(group Ⅱ,n=10).After anesthesia the patients in group Ⅱ received intravenous SMC in a dose of 200mg/kg before operation and after heart rewarming respectively,while patients in group Ⅰ received the same volume of balanced salt solution.Central venous blood was withdrawed for serum MDA and PGI 2 measurement at the following time points:before operation(T 0), before heart ischemia(T 1),heart ishcemia 30min(T 2),reperfusion 10min(T 3),reperfusion 30min(T 4),CPB stop 30min(T 5) and 24h after reperfusion(T 6).Results Serum MDA in group Ⅰ increased gradually after CPB and rapidly after reperfusion,and was significantly higher at T 4,T 5 and T 6 than that at T 2(P<0.05 or P<0.01).MDA did not increase in group Ⅱ after reperfusion(P>0.05).MDA values in group Ⅱ were significantly lower than those at the corresponding values in group Ⅰ during ischemia as well as reperfusion period.Significant PGI 2 increase after CPB and decrease after reperfusion were observed in both groups(P<0.05).However,PGI 2 values of group Ⅱ were significantly lower than those of group Ⅰ at T 2 and T 6.Postoperative heart function recovery of group Ⅱ was superior to that of group Ⅰ.Conclusion SMC can significantly reduce lipid peroxidation following heart ischemia and reperfusion,inhibit rapid increase of PGI 2 during ischemia and facilitate postoperative heart function recovery.

关 键 词：心内直视手术 心肌缺血 复方丹参 再灌注损伤 脂质过氧化 前列环素 

分 类 号：R654.2[医药卫生—外科学]