黄芪注射液对心脏手术中脑血糖利用和乳酸浓度的影响

Effects of ntragalus injection on cerebral glucose metabolism and lactate concentration in patients undergoing cardiac operation

目的探讨黄芪注射液对体外循环（CPB）下行心脏瓣膜置换术患者脑血糖的利用和乳酸的影响。方法30例择期行心脏瓣膜置换术患者，随机分为：黄芪注射液组（A组）和对照组（B组），每组15例。两组的麻醉方法均相同，A组麻醉诱导后将黄芪注射液20ml加入100ml生理盐水中静脉滴注，B组静脉滴注等容积生理盐水。分别于给药前（T1），CPB降温至鼻温33℃（T2），主动脉阻断15分钟（T3），CPB复温至鼻温33℃（T4），CPB结束后0．5小时（T5）以及CPB结束后2小时（T6），测定桡动脉和颈静脉球部血糖浓度差[G（a—v）]，颈静脉球部的乳酸含量（Lac）。结果两组患者体外循环时间、主动脉阻断时间、手术时间无明显差异，与T1相比，两组T2、T3、T5、T6各时间点EG（a—v）差异有显著性（P〈0．05），而在T3，T6点上A组显著高于B组（JP〈0．05），两组Lac在CPBY开始后其浓度逐渐升高，T5点达到高峰，在T4、T5、T6点上A组均显著低于B组（P〈0．05）。结论静脉注射黄芪注射液可提高体外循环下行心脏瓣膜手术患者对葡萄糖的利用，增加脑的能量供应，减少乳酸的生成。

Objective To investigate the effects of astragalus injection on cerebral glucose me- tabolism and lactate concentration in patients undergoing cardiac valve replacement with cardiopulmonary bypass （ CPB ）. Methods 30 patients scheduled for valve replacement were randomly divided into two groups： astragalus injection group （ group A ） and control group （ group B ）. Anesthesia induction and maintenance were same in two groups. In group A, astragalus injection 20ml was given i.v. after induction of anesthesia. In group B normal saline was given instead of astragalus injection. The blood samples were collected from jugular bulb before injection（ T1 ）, at the moment of 33 ℃ cooling（ T2 ）, stable hypothermic duration （ T3 ）, 33℃ rewarming（ T4 ）, 0.5 h（ T5 ）, 2 h （ T6 ） after CPB for determination of arterial and jugular bulb blood glucose, utilization of glucose[G （ a-v ）] and extraction of lactate （ Lac ）. Results At points of T2, T3, T5, T6 G （ a-v ） in two groups was markedly lower than those at T1 （ P〈 0.05 ）. At points of T3, T6 G（ a-v ） was significantly higher in group A than that in group B （P〈0.05 ）.The level of Lac increased after beginning of CPB and reached peak value at TS. At points of T4, T5, T6, The level of Lae was significantly lower in group A than that in group B （ P〈0.05 ）. Conclusion Astragalus injection may improve cerebral glucose utilization , and decrease the extraction of lactate.