体外循环对血管内皮细胞的影响及干预性治疗的研究

Influence of cardiopulmonary bypass on vascular endothelial cell and effects of intervention therapy

目的研究体外循环(CPB)对血管内皮细胞的影响及参附注射液在CPB过程中对血管内皮细胞的保护作用。方法66例行心内畸形矫治术的先天性心脏病患者,随机分为实验组(n=33)与对照组(n=33),均在全麻低温体外循环下行心内直视手术,围术期对症支持处理;实验组在体外循环预充液中加入参附注射液2ml/kg,而对照组预充液中不用参附注射液,其他处理与实验组相同。分别于麻醉诱导后,体外循环30min,开放升主动脉5min、15min,停机2h,共5个时点抽取桡动脉血,检测肿瘤坏死因子(TNF-α)、血栓调节蛋白(sTM)、P选择素(sP-selectin)的表达值。结果两组患者TNF-"、sTM、sP-selectin水平在CPB后均显著升高,与麻醉诱导期比较差异有统计学意义(P<0.01);实验组上升幅度较对照组小(P<0.05或P<0.01)。结论CPB对血管内皮细胞有损伤作用,参附注射液对CPB所致的血管内皮细胞损伤有一定的保护作用。

Objective To investigate the injury of vascular endothelial cells during cardiopulmonary bypass （CPB） and the protective effect of Shenfu injection （SFI）. Methods Sixty six children with congenital heart disease were randomly divided into the treated group （n=33） and the control group （n=33）. In the treated group, Shenfu injection （2 ml/kg） was added into cardiopulmonary-bypass circuit priming before CPB.In both groups, arterial blood samples were taken at the following time-points： after induction of anesthesia, 30 min after the start of CPB, 5 min, 15 min after declamping of aorta, 2 h after the end of CPB. Tumor necrosis factor-alpha （TNF-α）, soluble thrombomodulin and soluble P-selectin were measured by doubled antibodies sandwich enzyme-linked immunosorbent assay. Results Plasma levels of TNF-α, soluble thrombomodulin and soluble P-selectin between two groups showed no difference before CPB and all increased during and after CPB （P〈0.01）. However, in the treated group, the concentrations of TNF-α, soluble thrombomodulin and soluble P-selectin were significantly reduced compared with the control group at 30 min after the start of CPB, 5 min, 15 min after declamping of aorta, 2h after the end of CPB （P〈0.05 or P〈0.01）. Conclusion CPB induced the injury of vascular endothelial cells during surgery for congenital heart disease with CPB. Circuit priming with Shenfu injection might protect vascular endothelial cells from injury induced CPB.