参附注射液对心脏瓣膜置换患者脑损伤的影响

The effects of Shenfu injection on brain injury in patients undergoing valve replacement

目的:观察参附注射液(Shenfu injection,SFI)用于体外循环心肺转流术(Cardopulmonary bypass,CPB)心脏瓣膜置换术时对患者术中脑氧供需平衡的影响及脑缺血损伤保护作用,探讨其疗效及最佳给药方式。方法:32例体外循环下心脏瓣膜置换患者,年龄25～54岁,心功能2～3级,随机分为4组,每组8例。E1组在气管插管后主动脉阻断前泵注SFI1.5ml/kg;E2组在开放主动脉后泵注SFI1.5ml/kg;E3组分别于主动脉阻断前和开放主动脉后泵注SFI0.75ml/kg;C组为对照组,在气管插管后输注等量生理盐水1.5ml/kg。在气管插管后(T1)、体外循环转机10min(T2)、体外循环低温恒温期(T3)、复温至33℃(T4)、体外循环停机(T5)、体外循环结束后1h(T6)6个时间点采集静脉血(颈内静脉球部置管)和动脉血(桡动脉置管),分别进行动静脉血气分析及血浆S100β蛋白和丙二醛(MDA)、谷氨酸(Glu)含量及SOD活力测定。结果:E1、E2、E3组CERO2、SjvO2变化较C组稳定,且术中SjvO2明显高于C组(P<0.05),3组间上述指标差异无统计学意义(P>0.05)。E1、E2、E3组中,血浆S100β蛋白和MDA、谷氨酸Glu含量上升幅度小于C组(P<0.05),且在T6时刻E3组中各指标含量最低,差异有统计学意义(P<0.05);C组中SOD活力于CPB开始后明显降低,E1、E3组改变不明显,T6时刻E3组SOD活力最高,与C组、E1组比较差异有统计学意义(P<0.05)。结论:SFI能维持心脏瓣膜置换患者术中脑氧供需平衡,降低血清中S100β蛋白、MDA和Glu含量,提高SOD活力,有较好的脑保护作用,且采取主动脉阻断前及开放主动脉后分别泵注0.75ml/kg的方法效果最明显。

Objective：To investigate the effects of Shenfu injection on cerebral oxygen balance and cerebral ischemia-reperfusion injury in patients undergoing valve replacement during cardiopulmonary bypass,in order to Explore its efficacy and find reasonable route of administration. Methods： 32 patients undergoing valve replacement, aged 25 -54, with the heart function of 2 -3 level, were randomly divided into four groups with eight in each. Patients in group E1 received SFI 1.5 ml/kg before blocking of the aorta;Patients in group E2 received SFI 1.5 mt/kg after opening of the aorta;Patients in group E 3received SFI 0.75 ml/kg before blocking and after opening the aorta, too. Patients in group C received 0.9% NaCl. Blood samples were taken from internal jugular vein and arteria radialis after trachea cannula（T1 ）, 10 min after CPB（T2）,cooling stability stage（T3）,recovery temperature to 33℃（T4）,the end of CPB（T5） and 1 hour after the end of CPB （T6）for blood gas analysis.Then, Plasma S 100β protein concentration, MDA, Glu and the activity of SOD in jugular vein bulb were determined. Results： The CERO2, SjvO2 changes in Group E1, E2, E3 were stable, moreover, SjvO2 was significantly higher than that in group C （P 〈0.05）.There were no difference in these three groups.In Group E1,E2,E3,the S100β plasma protein and MDA,Glu were lower than those in group C （P 〈0.05 ）, and at T6, these indicators were the lowest in E3（P 〈0.05 ） ; SOD activity significantly decreased at the start of CPB in group C（P 〈0.05 ）, however, there were no obvious change after administrotion SFI（P〉0.05）, In group E3, SOD had the highest activity at T6 （P 〈0.05 ）. Conclusion：SFI maintain a heart valve replacement in patients with cerebral oxygen balance, reduce serum S100β protein, MDA and Glu content and enhance the activity of SOD, so it has effect on cerebral protection. Furthermore, the E3 group had the best effect.