参附注射液联合无创肢体缺血预处理对二尖瓣置换术病人心肌保护的研究  

Myocardial Protection of Shenfu Injection and Non-invasive Limb Ischemic Preconditioning in Mitral Valve Replacement

作　　者：吴军[1] 莫绍雄[1] 罗玉忠[1] 郭艺贞[1] 丁艺[1] 杨小平[1] 韦懿桐[1] Wu Jun;Mo Shaoxiong;Luo Yuzhong;Guo Yizhen;Ding Yi;Yang Xiaoping;Wei Yitong(The First Affiliated Hospital,Guangxi University of Traditional Chinese Medicine,Nanning 530023 Guangxi,China)

机构地区：[1]广西中医药大学第一附属医院,南宁530023

出　　处：《中西医结合心脑血管病杂志》2018年第5期574-576,共3页Chinese Journal of Integrative Medicine on Cardio-Cerebrovascular Disease

基　　金：广西壮族自治区中医药民族医药自筹经费科研课题(No.GZZC13-04)

摘　　要：目的探讨参附注射液(SFI)联合无创肢体缺血预处理(NLIPC)对二尖瓣置换术病人心肌的保护作用。方法选取择期二尖瓣置换术病人32例,随机分为对照组、SFI组、NLIPC组、SFI联合NLIPC(SFI+NLIPC)组,各8例。SFI组在术前30 min经中心静脉和开放主动脉后经体外循环(CPB)泵入SFI 1.5 mL/kg;NLIPC组对病人左下肢实施5 min缺血/5 min再灌注处理,连续重复该过程3次;SFI+NLIPC组联合使用SFI和NLIPC,对照组为常规CPB。检测4组心肌损伤生化指标,观察心脏复跳情况和术后多巴胺使用情况。结果 SFI+NLIPC组肌酸激酶同工酶(CK-MB)、心肌肌钙蛋白Ⅰ(cTnⅠ)、丙二醛(MDA)升高程度明显低于其他3组(P<0.01);术后心脏复跳率高于对照组(P<0.05);多巴胺用量低于其他3组(P<0.05)。结论联合使用SFI和NLIPC对缺血再灌注心肌具有较好的保护作用。Objective To investigate the effect of Shenfu injection(SFI),and noninvasive limb ischemic preconditioning(NLIPC)on myocardial ischemia-reperfusion injury(IRI)in mitral valve replacement(MVR).Methods Thirty-two patients undergoing elective MVR were randomly assigned into four groups:control group,SFI group,NLIPC group and the combination treatment of SFI and NLIPC(SFI+NLIPC)group.In SFI group,1.5 mL/kg SFI was respectively transfused through central vein 30 minutes before the operations and pumped via CPB as soon as the clamped aorta was unclamped.NLIPC group implement 5 min ischemia/5 min reperfusion treatment for patients with left lower limb,repeat the process 3 times in a row.SFI+NLIPC group received both SFI and NLIPC.Control group received intermittent cold crystalloid cardioplegia perfusion.Creatine kinase-MB(CK-MB),cardiac troponin I(cTnI),malondialdehyde(MDA)were determined in every group respectively at different times.The dosage of vaso-active drugs used after operation and the percentage of recovering spontaneous heart beat were recorded.Results The contents of CK-MB,cTn-I,MDA in SFI+NLIPC group increased less than those in other three group(P<0.01).SFI+NLIPC group had higher percentage of recovering spontaneous heart beat than other groups(P<0.05).The use of dopamine was lowest in SFI+NLIPC group(P<0.05).Conclusion Shenfu injection and NLIPC have better protective effect on ischemia-reperfusion myocardium.

关 键 词：二尖瓣置换术 缺血再灌注损伤 参附注射液 无创肢体缺血预处理 心肌 肌酸激酶同工酶 肌钙蛋白I 丙二醛 

分 类 号：R654.2[医药卫生—外科学] R289.5[医药卫生—临床医学]