甘利欣对体外循环患者急性肺损伤的保护作用

Effects of diammonii glycyrrhizinatis on acute lung injury induced by cardiopulmonary bypass

目的 研究甘利欣对体外循环(CPB)所致急性肺损伤的影响及其机制。方法24例风心病心内直视瓣膜置换术患者,随机分为两组,每组12例。甘利欣组(G),麻醉诱导后用10％葡萄糖注射液50ml加甘利欣2.5 mg·kg-1泵入,对照组(C)10％葡萄糖50 ml泵入。于麻醉诱导后10min(T0)、转流后30 min(T1)、开放主动脉后30 min(T2)、术毕(T3)、术后4 h(T4),术后24 h(T5)测血浆TNF-α、IL-1β、IL-11和丙二醛(MDA)的浓度及锰超氧化物歧化酶(Mn-SOD)的活性。测定麻醉诱导后10 min(t0)、体外循环后10min(t1)、30min(t2)、术毕(t3)的呼吸指数(RI)。结果 两组 TNF-α、IL-1β、IL-10、MDA和Mn-SOD在体外循环后均有不同程度的增高。G组TNF-α在T1和T2低于C组(P<0.05),在T1-L3、T5,C组IL-1β高于G组,IL-10低于G组(P<0.05);C组MDA在T2-T4高于G组(P<0.05);C组Mn—SOD的活性在T1、T2低于G组(P<0.05或0.01)。C组的RI在转流后升高,且在t1、t3高于G组。结论甘利欣可抑制心脏瓣膜置换术患者CPB引起的炎性反应,减少氧自由基产生,从而减轻体外循环所致的急性肺损伤。

Objective Diammonii glycyrrhizinatis was shown to exert a protective effect on myocardium against ischemia-reperfusion injury. The purpose of this study was to evaluate the effects of diammonii glycyrrhizinatis on acute lung injury induced by cardiopulmonary bypass(CPB), Methods Twenty-four ASA Ⅱ - Ⅲ patients (9 male, 15 female) aged 20-60 yr, weighing 45-75 kg scheduled for elective value replacement were divided into two groups at random: control group (group C, n = 12) and diammonii glycyrrhizinatis group (group G, n = 12) . Patients with infections diseases or immunodiflciency and those who were taking corticosteroid and drugs which may affect immune function were excluded. Anesthesia was induced and maintained with midazolam, fentanyl and vecuronium. In group G diammonii 2.5 mg·kg-1 10% glucose 50 ml was infused during the interval between intubation and skin incision. Blood samples were taken from arterial line at 10 min after induction (T0), 30 min after start of CPB (T1 ), 30 min after aortic unclamping (T2), at the end of surgery (T3), 4 h and 24 h after operation (T5, 6) for determination of plasma TNT-α IL-β, IL-10, MDA levels and Mn-SOD activity. Respiratory index (RI) PA-aDO2/PaO2 ] was calculated at 10 min after induction of anesthesia (T0), 10 min and 30 min after CPB (T1, 2) and at the end of surgery. Results There was no significant difference in age body weight, CPB time and aortic cross clamping time between the two groups. The TNF-α, IL-β, IL-10, MDA levels and Mn-SOD activity were not significanttly different at T0 between the two groups, and increased significanttly after start of CPB in both groups ( P < 0.05 or 0.01). But TNF-a level was significantly lower at T, and T2 in group G than in group C (P < 0.05). IL-1β level was significantly lower at T1,3 in group G than in group C (P < 0.01 or 0.05). IL-10 level was significantly higher at T1,3 and T5 in group G than group C ( P < 0.05 or 0.01). The plasma MDA level in group G was significantly lower at T2,4 than that in the control group (P < 0.05) . Mn-SOD activity was significantly higher at T1, 2 in group G than that in group C ( P < 0.05). RI was significantly lower at T1 and T3 in group G than in group C ( P < 0.05) .Conclusion Diammonii glycyrrhizinatis has auti-iuflammatory and oxygen free radical reducing effects and could protect the lungs from acute injury indued by CPB.