心内直视手术中复方丹参的心肌保护作用

Protective Effect of Salvia Miltiorrhizae Composita on Myocardium in Patients Undergoing Open Heart Sugery

观察复方丹参液对心内直视手术心肌缺血再灌注氧自由基导致心肌细胞损伤的保护作用。方法：选择１８例先天性心室间隔缺损（ＶＳＤ）或房间隔缺损（ＡＳＤ）体外循环下心内直视手术患者。随机分为对照组（Ⅰ组， ９例）和复方丹参组（Ⅱ组， ９例）。Ⅰ组给予等容量平衡盐液， Ⅱ组于手术开始前及复温时心脏复跳前分别静脉给复方丹参 ２００ｍｇ／ｋｇ。两组分别于术前、心肌缺血３０ｍｉｎ、循环开放心肌再灌注３０ｍｉｎ时、停机后３０ｍｉｎ及术后２４ｈ分别测血清丙二醛（ＭＤＡ）、肌酸磷酸激酶（ＣＰＫ）、乳酸脱氢酶（ＬＤＨ）含量。结果：Ⅰ组心肌缺血及缺血再灌注各时间 ＭＤＡ、 ＣＰＫ和 ＬＤＨ值均显著高于术前值（ Ｐ＜０． ０５， Ｐ＜０． ０１）。 Ⅱ组心肌缺血期与术前比较，无显著性差异（Ｐ＞０．０５）。缺血再灌注各时间值与术前比较均显著增高（Ｐ＜０．０５），但与缺血３０ｍｉｎ比较无显著性差异。两组间比较，Ⅰ组ＭＤＡ、ＣＰＫ、ＬＤＨ均显著高于Ⅱ组同时间值（Ｐ＜０．０１）。结论：丹参有抗超氧阴离子自由基作用，降低脂质过氧化程度，对缺血及缺血再灌注心肌有良好的保护作用。

To observe the protective effect of Salvia Miltiorrhizae Composita (SMC) on myocardium injuries induced by oxygen free radicals from ischemic reperfusion in patients undergoing open heart surgery. Methods: Eighteen patients with either congenital ventricular septal defect (VSD) or atrial septal defect (ASD) were divided randomly into control group and treated group, 9 in each. Patients in treated group were administered intravenously SMC 200 mg/kg before Operation and in rewarming period, while patients of the control group received the same volume of balanced salt solution. Serum malonyldialdehyde (MDA), creatine phosphokinase (CPK) and lactate dehydrogenase (LDH) were measured before operation, 30 min after myocardium ischemia, 30min after reperfusion, 30 min after cardiopulmonary bypass and 24 hours after operation. Results: Serum MDA, CPK and LDH levels in the treated group at both myocardium ischemic period and ischemic reperfusion period were significantly higher than those at before operation (P<0.05, P<0.01). In the treated group, levels of the 3 indexes at myocardium ischemic period increased slightly in comparison with those before operation (P>0.05), and the levels of them at ischemic reperfusion period were significantly higher than those before operation (P<0.05), but there was no significant difference between the levels at ischemic reperfusion period and those at 30 min after myoccardium ischemia. Comparison between the two groups showed that the serum MDA, CPK and LDH levels were all significantly higher in the control group than those in the control group respectively in all periods (P<0.01). Conclusions: SMC could effectively protect myocardium from ischemia and ischemic reperfusion by attenuating the free radial damsge and inhibiting lipid peroxidation.