摘要
目的:观察参麦注射液对老年心脏瓣膜置换术患者围术期脂氧素A4(LXA4)等细胞炎症介质及肺氧合功能的影响。方法:选择本院2018年5月~2020年6月拟行心脏瓣膜置换术的患者42例,采用随机数字表法将患者分为研究组和对照组,每组21例。其中,男性23例,女性19例,年龄60~75岁,ASAⅡ~Ⅲ级。研究组麻醉诱导插管后体外循环(CPB)转机前将参麦注射液0.6 ml/kg加入250 ml生理盐水缓慢静脉滴注,同时CPB预充液中加入参麦注射液0.6 ml/kg,对照组在同期给予等容量的生理盐水。分别于麻醉诱导前(T_(1))、CPB停机时(T_(2))、停机后2 h(T_(3))、6 h(T_(4))、24 h(T_(5))、48 h(T_(6))时采集静脉血样测定肿瘤坏死因子-α(TNF-α)、白介素-8(IL-8)、IL-10和LXA4水平。计算各时点肺泡-动脉血氧分压差(PA-aDO_(2))、呼吸指数(RI)和氧合指数(OI);记录机械通气时间、重症监护治疗病房(ICU)驻留时间等。结果:T_(2~5)时点研究组TNF-α和IL-8水平低于对照组,LXA4和IL-10水平高于对照组(P<0.05);T_(2~5)时点研究组PA-aDO_(2)、RI低于对照组,T_(3~5)时点研究组OI高于对照组(P<0.05);与对照组比较,研究组机械通气时间、ICU停留时间更短(P<0.05)。结论:参麦注射液用于老年心脏瓣膜置换术患者围术期,可抑制促炎症细胞因子TNF-α和IL-8水平的升高,增强抗炎症细胞因子IL-10和促炎症消退介质LXA4的释放,促进全身炎性反应的消退,减轻CPB术后急性肺损伤,有利于患者康复。
Objective:To observe the effects of Shenmai injection on cell mediators such as lipoxin A4(LXA4)and lung oxygenation function in elderly patients undergoing valve replacement surgery.Methods:Forty two patients(23 males and 19 females,aged 60~75 years,ASAⅡ~Ⅲ)scheduled for cardiac valve replacement in our hospital from May 2018 to June 2020 were selected.The patients were randomly divided into two groups by random number table method,21 cases in each group.In research group,0.6 ml/kg of Shenmai injection was added into 250 ml normal saline before cardiopulmonary bypass(CPB),and 0.6 ml/kg of Shenmai injection was added into CPB priming solution.In control group,the same volume of normal saline was given at the same time.Venous blood samples were collected at before induction of anesthesia(T_(1))and 0 h(T_(2)),2 h(T_(3)),6 h(T_(4)),24 h(T_(5)),48 h(T_(6))after the end of CPB to determine the levels of tumor necrosis factor-α(TNF-α),interleukin-8(IL-8),IL-10 and LXA4.alveolar arterial oxygen differential pressure(PA-aDO_(2)),respiratory index(RI)and oxygenation index(OI)were calculated at each time point.Mechanical ventilation time and ICU stay time were recorded.Results:At T_(2~5),the levels of TNF-αand IL-8 in research group were significantly lower than those in control group,while the levels of LXA4 and IL-10 in research group were significantly higher than those in control group(P<0.05).At T_(2~5),PA-aDO_(2) and RI in research group were significantly lower than those in control group,and OI in research group was significantly higher than that in control group at T_(3~5)(P<0.05).Compared with control group,the duration of mechanical ventilation and ICU stay in research group were significantly shorter(P<0.05).Conclusion:Shenmai injection was used in elderly patients with heart valve replacement during perioperative period,which can inhibit the increase of pro-inflammatory factors TNF-αand IL-8,enhance the release of anti-inflammatory factor IL-10 and pro-inflammatory mediator LXA4,promote the regression o
作者
魏利娟
陈小莉
郭仲辉
马亚飞
WEI Li-juan;CHEN Xiao-li;GUO Zhong-hui;MA Ya-fei(the First Affiliated Hospital,and College of Clinical Medicine of Henan University of Science and Technology,Luoyang 471000,China)
出处
《中国合理用药探索》
2021年第7期59-64,共6页
Chinese Journal of Rational Drug Use
基金
河南省医学科技攻关计划项目(201602167)
河南省科技计划项目(172102310686)。
关键词
参麦注射液
脂氧素
体外循环
全身炎性反应
肺损伤
Shenmai injection
lipoxin
extracorporeal circulation
systemic inflammatory response
lung injury
