参附注射液对体外循环下二尖瓣置换术患者血清炎性递质及早期肾损伤的影响

Effect of Shenfu injection on serum inflammatory mediators and early renal injury in patients undergoing mitral valve replacement under cardiopulmonary bypass

目的观察参附注射液对体外循环(CBP)下二尖瓣置换术(MVR)患者血清炎性递质及早期肾损伤的影响。方法将121例择期行MVR的患者随机分为观察组61例及对照组53例,观察组在麻醉诱导前及术后给予参附注射液治疗,连用至术后96 h,对照组给予同等剂量生理盐水处理,其他治疗措施同观察组。观察2组麻醉诱导前(t_0)及术后24 h(t_1)、48 h(t_2)、72 h(t_3)、96 h(t_4)炎性递质如血清可溶性细胞间黏附分子-1(s ICAM-1)、C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、内皮素-1(ET-1)水平,以及肾功能指标[血清肌酐(Cr),尿素氮(BUN)]、尿中性粒细胞明胶酶相关脂质运载蛋白(NGAL)、尿N-乙酰-β-D氨基酸葡萄糖苷酶(NAG)浓度,并统计2组不同时间点尿量的变化情况。结果 2组术后血清s ICAM-1、CRP、TNF-α、ET-1水平均较t_0显著升高,均在t_2达到高峰后开始降低,观察组上述指标在t_1、t_2、t_3、t_4均显著低于对照组(P均<0.05);2组术后Cr、BUN水平与t_0比较差异均无统计学意义(P均>0.05),且2组间比较差异均无统计学意义(P均>0.05);2组术后尿NGAL、NAG水平均较t_0显著升高,均在t_2达到高峰后开始降低,观察组上述指标在t_1、t_2、t_3、t_4均显著低于对照组(P均<0.05)。观察组术中、术后1~4 d的尿量均显著高于对照组(P均<0.05)。结论参附注射液能够减轻CBP下行MVR患者的肾损伤,具有一定肾功能保护效应,其机制可能与抑制血清s ICAM-1、CRP、TNF-α、ET-1水平有关。

Objective It is to observe the effect of Shenfu injection on serum inflammatory mediators and early renal injury in patients undergoing mitral valve replacement（ MVR） under cardiopulmonary bypass（ CBP）. Methods One hundred and twenty-one patients undergoing MVR were randomly divided into observation group（ n = 61） and control group（ n = 53）. The observation group was given Shenfu injection before anesthesia induction and after operation,the treatment lasted for 96 h after operation. The control group was given the same dose of normal saline at the same time. The other treatment was the same in both groups. The levels of inflammatory mediators like sI CAM-1,CRP,TNF-α,ET-1,renal function indicators（ SCr,BUN）,neutrophil gelatinase-associatedlipocalin（ NGAL）,amino acids glycosidase enzymes（ NAG） were observed in both groups before anesthesia induction（ t0）,in 24 h（ t1）,48 h（ t2）,72 h（ t3）,96 h（ t4） after operation. The urine volume at every time point was recorded. Results The levels of serum sI CAM-1,CRP,TNF-α and ET-1 after operation were significantly higher than that at t0 in both groups,and they began to decrease when reached their peak value at t2,the levels at t1,t2,t3,t4 in observation group were lower than that in control group（ P〈0. 05）. The levels of Cr,BUN after operation had no significant difference compared with that at t0 in both groups（ P〉0. 05）,no difference was found between the two groups（ P〉0. 05）. The levels of urine NGAL and NAG after surgery were significantly higher than that at t0 in both groups,and they began to decrease when reached their peak value at t2,the levels at t1,t2,t3,t4 in observation group were lower than that in control group（ P〈0. 05）. The urine volume during surgery and in 1-4 days after operation in observation group was more than that in control group（ P〈0. 05）. Conclusion Shenfu injection could relieve renal function in the patients undergoing MVR under CBP,the protecting effect on renal function may be related with inhibition of serum sI CAM-1,CRP,TNF-α and ET-1.