血管内皮活性因子在止血带诱发肺换气功能损伤中的作用及参麦注射液的干预效果

Role of vascular endothelial active facters in gas exchange impairment induced by tourniquet and the effect of Shenmai injection

目的:观察血管内皮活性因子一氧化氮(NO)和内皮素-1(ET-1)在止血带诱发肺换气功能损伤中的作用及参麦注射液对其的干预效果。方法:选择单侧下肢手术患者(需要上止血带)26例,按单盲法随机分为对照组(C组,n=14)和参麦注射液组(SM组,n=12)。于L2,3间隙行脊椎-硬膜外联合阻滞。SM组于上止血带15 min前将参麦注射液0.6 mL.kg-1加入100 mL生理盐水静脉滴注完毕,C组在相同时间内滴注等量的生理盐水。动态观察2组患者上止血带前(T0)、松止血带后30 min(T1),2 h(T2),6 h(T3),24 h(T4)5个时点血气指标及血NO和ET-1的浓度变化。结果:与T0时比较,C组T3时动脉血氧分压、血NO浓度降低,肺泡-动脉血氧分压差和血ET-1浓度升高(P<0.05,P<0.01);SM组T3时血NO浓度降低(P<0.05),各时点血气指标和血ET-1浓度比较差异无统计学意义。与C组比较,SM组松止血带后的动脉血氧分压和血NO浓度降低幅度减慢,肺泡-动脉血氧分压差、血ET-1浓度升高幅度降低(P<0.05)。结论:NO和ET-1参与止血带诱发的肺换气功能损伤过程,参麦注射液有改善肺换气功能,其机制可能与参麦注射液有提高NO、降低ET-1水平有关。

Objective： To investigate the effect of Shenmai injection on vascular endothelial active facters nitric oxide （NO） and endothelin-1 （ ET-1 ）, and pulmonary gas exchange induced by tourniquet deflation in patients undergoing lower extremity surgery. Method： Twenty-six patients scheduled for unilateral lower extremity surgery were randomly divided into 2 groups： control group （group C, n = 14） and Shenmai injection group （group SM, n = 12）. All the patients agreed to a combined spinal-epidural anesthesia at the L2-L3 interspace and a radial artery catheter was placed for sampling. Patients in group SM were injected Shenmai injection 0.6 mL · kg^-1 and physiological saline 100 mL,while patients in group C were injected equal volume of normal saline instead 15 min before tourniquet inflation. Blood samples which were used for blood gas analysis and measurement of nitric oxide （NO） and endothelin-1 （ET-1） were taken before tourniquet inflation （To, baseline） and 30 min （T1 ）, ：2 h （T2 ）, 6 h （T3 ）, 24 h （T4 ） after tourniquet de- flation. Result： Compared with the baseline values at To, in group C at T3 PaO2and the levels of NO were significantly decreased, while PA-aDO2 and the levels of ET-1 at T3 were significantly increased （P 〈 0. 05 or P 〈 0. 01 ）, in group SM, the levels of NO at T3 were significantly decreased （P 〈0. 05 ）. Compared with group C, the changes of PaO2, PA-aDO2, NO and ET-1 were significantly mitigated in group SM. Conclusion： The concentrations of NO and ET-I is connected with the pulmonary gas exchange impairment in- duced by tourniquet application. Shenmai injection can improve the pulmonary gas exchange based on rising the level of NO, reducing the level of ET-1.