参麦注射液对浅低温体外循环心脏手术患者脑损伤标志物和乳酸的影响

Effect of Shenmai Injection on Brain Damage Markers and Lactic Acid in Patients Undergoing Cardiac Surgery during Mild Hypothermic Cardiopulmonary Bypass

目的探讨参麦注射液(SMI)对浅低温体外循环(CPB)心脏手术患者脑损伤标志物和乳酸的影响,为CPB心脏手术患者脑保护提供理论依据。方法将浅低温CPB下行心脏瓣膜置换术的20例患者随机分为SMI组(S组)和对照组(C组),每组10例。麻醉诱导后,S组静脉滴注SMI(0.6ml/kg加至250ml生理盐水),C组同时间内给予等量生理盐水,于转机前滴注完毕。分别于转机前(T0)、停机后1h(T1)、6h(T2)、24h(T3)由颈内静脉球部抽取静脉血,测定乳酸(Lacjv)、神经特异性烯醇化酶(neuron-specific enolase,NSE)和S-100β的浓度,记录两组患者主动脉阻断时间、CPB时间和麻醉维持时间。结果两组患者主动脉阻断时间、CPB时间、麻醉维持时间、转机前血清Lacjv和NSE水平无统计学意义(P>0.05)。与T0比较,两组患者血清Lacjv和NSE水平随停机时间延长而升高,于T2时点达高峰,T3时点有所下降(P<0.01或P<0.05),S组两指标均恢复至T0水平(P>0.05);S组停机后各时点血清Lacjv和NSE上升幅度均低于C组(P<0.01或P<0.05),两组血清S-100β均未测得。结论 CPB前静脉滴注SMI可以减少心脏手术围术期颈静脉球部血乳酸和NSE的上升幅度,对CPB心脏瓣膜置换术后患者脑损伤具有一定的防护作用。

Objective To investigate the effect of Shenmai injection（SMI） on brain damage markers and lactic acid in patients undergoing cardiac surgery during mild hypothermic cardiopulmonary bypass（CPB） and provide patients who undergo such a surgery theoretical basis for brain protection.Methods Twenty patients,scheduled to receive cardiac valve replacement with mild hypothermic CPB,were randomly allocated into two groups： the SMI group（S group） and the control group（C group）.Surgery was performed under CPB after general anaesthesia.SMI 0.6ml/kg was given to the S group by adding in 250ml normal saline for intravenous dripping at the time between anaesthesia induction and CPB,while the C group received normal saline instead of SMI.Blood-gas analysis was performed with blood withdrawal from the jugular veins bulb to record lactic acid,with blood remained to measure Neuron-Specific Enolase（NSE） and S-100βat various time points,i.e.before CPB（T0）,1h（T1）,6h（T2） and 24h（T3） after stoping CPB.The duration of aortic cross-clamp,CPB and anesthesia of both groups at the end of operation were recored.Results The duration of aortic cross-clamp,CPB,anesthesia,the level of lactic acid and NSE before CPB were not significantly different between two groups（P0.05）.Compared with T0,Lacjv and NSE were gradually elevated and reached the peak at T2,and both unobviously reduced at T3 after ending CPB（P0.01 or 0.05）.The two indicators from S group fell back to T0 levels after CPB（P0.05）,and their increment was lower than them in C group（P0.01 or 0.05）.S-100βdid not appear to have been obtained in both groups.Conclusion Intravenous dripping SMI before CPB can reduce the production of lactic acid and NSE during perioperation,and plays the role of protecting patients who undergo cardiac valve replacement by mild hypothermic CPB from brain injury.