银杏叶提取物金纳多对低温体外循环脑损伤的保护作用

Brain Protective Effects of Ginkgo Biloba Leaf Extract (Ginaton) in Patients Undergoing Hypothermic Cardiopulmonary Bypass

目的 探讨银杏叶提取物金纳多对低温体外循环脑损伤的保护作用。方法 择期行风湿性心脏病二尖瓣置换术患者60例，美国麻醉医师协会（American Society of Anesthesiologists，ASA）分级Ⅱ～Ⅲ级，静脉麻醉后，按随机数字表法随机分为两组。银杏组（30例）：开胸之前给予银杏叶提取物（金纳多）1mg／kg，静脉滴注，体外循环（CPB）开始前滴完；对照组（30例）：以等量生理盐水同速度静脉滴注。分别在CPB开始前（T1）、鼻咽温（降至30～31℃）稳定期（T2）、鼻咽温复温至36℃（T3）、CPB结束后30min（T4）、CPB结束后3h（T5）5个时点同步采集桡动脉和颈内静脉血，测定血气、乳酸浓度、血浆超氧化物歧化酶（SOD）活性及血浆丙二醛（MDA）含量，并计算动脉及颈内静脉血氧含量（Ca02，Civo，）、动一颈静脉血氧含量差（Ca-jvO2）、脑氧摄取率（ER0O）和动-颈内静脉血乳酸浓度差（ADVL）。结果 CPB开始后银杏组Ca-jvO2、ERO2降低的幅度明显大于对照组（P〈0．05或P〈0．01），乳酸浓度、ADVL、MDA含量升高的幅度明显低于对照组（P〈0．05或P〈0．01），SOD活性明显高于对照组（P〈0．01）。结论 低温体外循环期间银杏叶提取物金纳多能改善脑氧供需平衡，提高SOD活性，抑制自由基生成，具有明显的脑保护作用。

Objective To investigate the brain protective effects of Ginkgo biloba leaf extract（Ginaton）in patients who underwent hypothermic cardiopulmonary bypass （CPB）. Methods Sixty patients with rheumatic heart disease of ASA grade Ⅱ-Ⅲ, who were scheduled for mitral valve replacement with intravenous anaesthesia, were randomly assigned to two groups, the Ginaton group （30 patients） treated with Ginaton 1 mg/kg by intravenous dripping before open heart for CPB, and the control group （30 patients） with normal saline instead. Blood was synchronously collected from arteriae radialis and vena jugularis interna at 5 time points, namely, be- fore CPB （T1）, nasopharyngeal temperature （lowered to 30- 31℃ ） stabilized stage （T2）, nasopharyngeal bemperature restoration （36℃） stage （T3）, 30 min after CPB （T4） and 3 h after CPB （Ts） for determining blood gas, lactate acid concentration, activity of superoxide dismutase （SOD） and malonaldehyde （MDA） content. And the oxygen content in artery （CaO2） and jugular vein （CjvO2）, the difference of oxygen contents in arterial and jugular vein （Ca- jvO2）, the cerebral oxygen extraction ratio （ERO2） as well as the arteriojugular lactate difference （ADVL） were calculated. Results After the beginning of CPB, as compared with those in the con- trol group, in the Ginaton group, the reduction of Ca- jvO2 and ERO2 was significantly higher （P 〈 0.05 or P〈0.01） and the increase of lactate acid, ADVL and MDA were significantly lower, and with a remarkably higher SOD activity （P 〈 0.01 ）. Conclusion Ginaton could improve cerebral oxygen supply, promote SOD activity to inhibit production of free radicals in patients undergoing CPB, and thus shows an evident protective effect in the brain.