含银杏叶提取物的肺保护液对心内直视术患者肺的保护作用

Protection for lung by pulmonary artery perfusion with hypothermic protective solution contained ginkgo biloba extract during cardiopulmonary bypass

目的探讨体外循环(CPB)期间肺动脉灌注低温含银杏叶提取物的肺保护液对MDA、IL-6和TNF-α的影响,观察其对肺脏的保护作用。方法30例二尖瓣置换术患者随机等分为保护组和对照组,均在CPB下行心内直视术,保护组CPB期间经肺动脉灌注低温含银杏叶提取物的保护液,对照组灌注等量生理盐水,其他处理与保护组相同。监测CPB前和CPB后0、6、12和24h患者的血氧指数、血浆丙二醛(MDA)、肿瘤坏死因子α(TNF-α)及白细胞介素6(IL-6)的变化,并观察肺组织形态学改变。结果保护组各时点血氧指数均高于对照组(P<0.05),CPB后血浆MDA、IL-6和TNF-α水平较术前升高(P<0.05);在CPB后各时间点,肺保护组患者血浆IL-6、TNF-α和MDA均低于对照组(P<0.05);对照组肺组织可见中性粒细胞浸润、肺间质水肿、肺泡壁小血管扩张、充血,保护组肺组织炎性反应较轻微。结论CPB可引起患者术后血浆MDA、IL-6和TNF-α水平升高;经肺动脉灌注低温含银杏叶提取物的肺保护液可抑制心内直视术后患者血浆MDA、IL-6以及TNF-α的表达,减轻肺组织的炎性损伤。

[Objective]To explore the lung protection by peffusion of pulmonary artery with hypothennic protective solution contained ginkgo biloba extract during cardiopulmonary bypass. [Methods] 30 cases undergoing mitral valve replacement were randomly divided averagely into protective group and control group. Hypothermic protective solution contained ginkgo biloba extract was infused to pulmonary artery in the protective group, and Sodium Chloride was infused to pulmonary artery in the control group. Patients lung functions were monitored. Concentrations of plasma malondialdehyde（MDA）, tumor necrosis factor-α（TNF-α） and interleukin-6（IL-6） were measured at differ- ent time point before and after cardiopulmonary bypass. Lung biopsy specimens were obtained after operations to study histological changes. [Results] The oxygen index was higher in the lung protect group than that of in the con- trol group at 0, 6, 12 and 24 h after CPB（P 〈0.05）. In both groups, compared with the baseline values, plasma levels of MDA, IL-6 and TNF-α were gradually increased after CPB. Compared to the control group, the level of MDA, IL-6 and TNF-α were lower in the protective group at different time point after CPB （P 〈0.01）. Histologic analyses showed intra-alveolar edema, capillary hyperemia and neutrophil accumulated in the control group, whereas no sig- nificant changes in the protective group.[Conclusions] CPB could induce the increasing of MDA, IL-6 and TNF-α levels in patient＇s plasma after heart surgery. Hypothermic protective solution contained ginkgo biloba extract per-fused through pulmonary artery can significantly inhibit the increasing of MDA,IL-6 and TNF-α levels in plasma after CPB and reduce the inflammatory response of lung during cardiopulmonary bypass.