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1. 重庆医科大学附属第一医院麻醉科
2. 重庆市中山医院麻醉科
纸质出版日期:2009,
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[1]邹磊,刘丹彦,曹宇.参附注射液对心脏瓣膜置换患者脑损伤的影响[J].重庆医科大学学报,2009,34(07):903-907.
ZOU Lei, et al. The effects of Shenfu injection on brain injury in patients undergoing valve replacement[J]. Journal of Chongqing Medical University, 2009,34(7):903-907.
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 ml/kg after opening of the aorta;Patients in group E3received 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 S100β 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.
参附注射液心肺转流术脑保护脑氧供需平衡缺血-再灌注损伤S100β蛋白
Shenfu injectionCardopulmonary bypasscerebral protectionCerebral oxygen balanceIschemia-reperfusion injuryS100β protein
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