参附注射液对心脏瓣膜置换患者手术中的心肌保护效果

Myocardial protective effect of Shenfu injection in patients undergoing valve replacement

目的探讨参附注射液加入停搏液中对心脏瓣膜置换手术中的心肌保护效果。方法40例择期在体外循环(CPB)下行瓣膜置换术的患者,随机分为参附注射液(SF 组)和对照组。对照组停搏液为氧合血与冷晶体液(改良 St Thormas 液)按4:1容量比例的混合液;SF 组在冷晶体液中加入20 ml/L 参附注射液,其他处理同对照组。分别于术前、主动脉开放后及停 CPB 后不同时间点采血,经处理后测定 CK、CK-MB 及 cTnI。结果两组在主动脉开放30 min 后 CK、CK-MB 及均明显升高,其中 CK、CK-MB 至停 CPB 后24 h 仍处较高水平。组间比较:停 CPB 后24 h SF 组与对照组相比CK 升高的程度明显低(P<0.05),CK-MB 浓度在主动脉开放后各时间点 SF 组升高的程度明显低于对照组。cTnI 在停 CPB 后24 h 有下降趋势,但仍高于术前水平,在主动脉开放30 min 至术后24 h 的时间点 SF 组与对照组相比 cTnI 升高的程度明显低(P<0.05)。SF 组心脏自动复跳例数明显多于对照组,而停机后需要多巴胺辅助循环的例数则明显少于对照组。结论参附注射液加入停搏液中可减少心肌酶的释放,增强心肌保护的效果。

Objective To investigate the myocardial protective effect of Shenfu injection in patients undergoing valve replacement. Methods Forty patients undergoing valve replacement surgery under cardiopulmonary bypass （CPB） were randomly divided into two equal groups ： group C （ control group, given with 4：1 blood containing cardioplegic liquid during the CPB） and group SF （ Shenfu injection, receiving the blood containing cardioplegic liquid with 20 ml/L of Shenfu injection additionally）. Blood samples were withdrawn from the central vein before operation, 30 minutes after aorta declamping , and 4, 12, and 24 hours after CPB, to test the serum cardiac troponin I （cTnI）, creatine phosphokinase （CK）, and creatine phosphokinase isoenzyne （CK-MB）. Results The CK, CK-MB, and cTnI level were normal before operation and there were no significant differences in these indexes between the two groups. 30 minutes after aorta declamping , the CK, CK-MB, and cTnI levels were higher than those before operation in both groups （ P 〈0.05, P 〈0. 01 ）, and the higher levels remained to 24 hours after CPB. 24 hours after CPB, the CK level of the group SF was significandy lower than that of the group C （ P 〈 0.05 ） , and 30 minutes after aorta declamping to 24 h after CPB, the CK-MB and cTnI levels were lower in the group SF compared with the group C （all P 〈 0. 05）. Conclusion Shenfu injection decreases the level of CK, CK-MB and cTnI, and reduces the myocardial injury.