黄芪注射液对体外循环下心脏瓣膜置换术后患者肾功能的影响

Effects of Astragalus Injection on Renal Function in Patients after Cardiac Valve Replacement with Cardiopulmonary Bypass

目的探讨黄芪注射液对体外循环(cardiopulmonary bypass,CPB)下心脏瓣膜置换术后患者肾功能的影响。方法选取40例体外循环下心脏瓣膜置换手术患者,分为黄芪组和对照组,每组20例。黄芪组于麻醉前以黄芪注射液40mL加入5%葡萄糖注射液250mL中静脉滴注,体外循环之前以黄芪注射液20mL加入预充液中,术后以黄芪注射液40mL加入5%葡萄糖注射液250mL中静脉滴注,每天1次,连用5天,对照组输等量乳林液。于麻醉前(T0)、术后1d(T1)、术后3d(T3)、术后5d(T5)、术后7d(T7),留取中心静脉血及晨尿,测定血清尿素氮(BUN),肌酐(Cr)、β2-微球蛋白(β2-MG)的浓度;取尿上清液,测定尿微量白蛋白(m-Alb)、尿β2-微球蛋白(β2-MG)、尿-N-乙酰氨基葡萄糖苷酶(NAG)水平。结果与T0时比较,对照组T1,3时血清BUN、Cr,T3时血清β2-MG,T1,3,5,7时尿β2-MG、m-Alb及NAG的水平升高,黄芪组T1,3,5时尿m-Alb、NAG及T1,3,5,7时尿β2-MG的水平升高(P<0.05);与对照组比较,黄芪组T1,3时血清BUN,T3时血清Cr和β2-MG,T1,3,5,7时尿β2-MG、m-Alb及NAG的水平降低(P<0.05)。结论CPB下心脏瓣膜置换术可以导致肾功能损害,围术期应用黄芪注射液对肾功能有一定保护作用。

Objective To observe the effects of Astragalus Injection（AI） on renal function in patients after cardiac valve replacement with cardiopulmonary bypass （CPB）. Methods Forty patients scheduled to receive cardiac valve replacement with CPB were randomly assigned to 2 groups equally, the control group and the AI group. Patients in the AI group were administered with AI 40mL before anesthesia by diluting it in 250 mL 5% glucose solution via intravenous dripping, 20 mL by adding it into the priming solution before CPB and 40 mL once a day diluted as before via intravenous dripping at the foremost 5 successive days after operation. For pa- tients in the control group, equal volume of Ringer＇s Liquid was given instead of AI. Peripheral blood sample and urine were collected at various time points： before anesthesia （T0）, the 1st （T1）, 3rd （T3）, 5th （T5） and7th day （T7） after operation, for determining blood levels of urea nitrogen （BUN）,creatinine （Cr） and β2-microglobulin （β2-MG）, as well as urinary levels of β2-MG, microalbumin （m-AIb） and N-acetyl-D-glucosaminidase （NAG）. Results As compared with those at To, in the control group, BUN, Cr at T, and T3, serum β2-MG at T3, urinary β2-MG m-AIb and NAG at T1-T7 were significantly higher, while in the AI group, urinary m-AIb, NAG at T1-5n and urinary β2-MG at T1-7 were higher （P 〈0.05）. As compared with those in the control group, serum BUN at T1-3, Cr and blood β2-MG at T3, urinary β2-MG, m-AIb and NAG at T1-7 were lower （P〈0.05） in the AI group. Conclusion CPB could induce renal failure, and applying AI at the perioperative stage can protect renal function to some certain extent.