摘要
目的研究黄芪在体外循环心脏瓣膜置换术中对心肌缺血-再灌注损伤的保护作用。方法将24例心功能Ⅱ-Ⅲ级风湿性心脏病首次择期行心内直视瓣膜置换术病人随机分成两组：黄芪组（n=12），入手术室开放静脉通路后即以黄芪注射液0.6 g/kg加入生理盐水稀释至60 ml泵入；对照组（n=12）以60 ml生理盐水泵入。在麻醉诱导后15 min（T0）、主动脉阻断前（T1）、主动脉阻断后20 min（T2）、主动脉开放后30 min（T3）、主动脉开放后2 h（T4）及术后24 h（T5）抽桡动脉血测CK、CK-MB、CTnI。结果T0时CK、CK-MB、CTnⅠ均在正常范围内，组间差异无统计学意义（P〉0.05）；T2-T5各时点CK、CK-MB、CTnⅠ均有不同程度升高：与T0相比，CK在T4、T5，CK-MB在T3-T5均有显著升高（P〈0.05），组间比较黄芪组CK在T2时显著低于对照组（P〈0.05）；两组CTnⅠ在T3-T5各时点较T0时升高明显，组间比较黄芪组CtnI显著低于对照组（P〈0.05）。结论黄芪可降低体外循环、心内直视瓣膜术中CTnI的释放，对此类手术中心肌缺血-再灌注损伤有保护作用。
Objective To investigate the cardioprotection effect of astragalus membranaceus during myocardial ischemia reperfusion injury（ MIRI ）in valve replacement with cardiopulmonary bypass （CPB）. Methods Twenty-four rheumatic heart disease cases with NYHAFC Ⅱ-Ⅲ underwent selective valve replacement were randomized into astragaluse membranaceus group （group A） and control group, with 12 for each. Astragalus membranacues （0.6 g/kg） was diluted to 60 ml with 0.9 % NS and continuously intravenous infused in group A, whereas simplex 0.9% NS 60 ml was infused in control group. Creatine kinase（CK） , creactine kinase-MB （CK-MB） , and cardiac troponin Ⅰ （CTnⅠ） were measured at 15 minutes after anesthesia induction （ T0 ） , before aortic cross-clamp（ T1 ） , 20 minutes after aortic clamping （ T2 ） , 30 minutes （ T3 ） and 2 hours （ T4 ） after aortic reopening, and 24 hours after operation （ T5 ）. Results （ 1 ） The concentration of CK, CKMB and CTnⅠ at To was normal, and there was no significant difference between two groups（ P 〉 0.05 ）. （2） The serum levels of CK, CK-MB and CTnl ascend in both groups at T2 - T5 time points： CK of T4 and T5 , CK-MB at T3 , T4 and T5 were obviously higher than those of To respectively （ P 〈0. 05 ） , furthermore there was statistic difference of CK at Tz between two groups （ P 〈 0.05 ）. CTnl was significant rising at T3 , T4, Ts than that of To in two groups （ P 〈 0.05 ）. Compare with control group, CTnl was remarkably lower in group A （ P 〈 0.05）. Conclusion Astragalus membranaceus could protect MIRI by reducing Ctnl level in CPB.
出处
《中国现代手术学杂志》
2007年第1期56-59,共4页
Chinese Journal of Modern Operative Surgery
关键词
黄芪
心肌再灌注损伤
肌酸激酶
肌酸激酶同工酶
肌钙蛋白Ⅰ
astragalus membranaceus
myocardial reperfusion injury
creatine kinase
creatine kinase isoenzymes
troponin Ⅰ
