护心宝在体外循环心内直视手术中心肌保护作用的研究

目的：探讨中药复方护心宝在体外循环心内直视手术中心肌保护作用的机理，并探讨MIRI的中医病机、治则。方法：风湿性心脏病瓣膜置换术者20例，随机分为对照组与治疗组各10例。术中动态监测心电；分别在入院术前(T1)、主动脉阻断30min(T2)及主动脉开放30min(T3)、60min(T4)、手术结束(约主动脉开放120min，T5)经锁骨下中心静脉取血，测定血清乳酸脱氢酶同工酶(LDH1)、肌酸磷酸肌酶(CK)、肌酸磷酸肌酶同工酶(CK—MB)、丙二醛（MDA)含量，超氟化物歧化酶(SOD)活力，一氟化氮(N0)和一氟化氮合成酶(HOS)活性。术毕留取小块病变心肌组织，电镜下观察超微结构的变化。结果：治疗组与对照组比较，可减轻心肌超微结构的损伤，减少心肌酶的释放、MDA的含量，提高SOD的活力、N0和NOS的活性(P＜0．05)。结论：MIRI中医病机为心气虚衰为本，心血瘀阻、浊毒内生为标，是一本虚标实证，其治则为益气活血解毒。护心宝对缺血心肌和MIRI均有保护作用。

Clinical Study on Myocardim Protection of Huxinbao during Open Heart Surgery of Cardiopnlmonary Bypass

Objective:To investigate the myocardium protection mechanism of Huxinbao in open heart surgery of cardiopulmonary bypass, the pathomechanism of MIRI and therapeutic principles in TCM. Methods:20 patients with rheumatic heart disease undergoing valve replacement open heart surgery were observed and randomly divided into two groups, the control group and the treated group (10 in each group). Blood samples were taken via subclavin central vein at the first day in hospital (T1), 30 min after aorta occlusion (T2), 30 min(T3) and 60 min (T4) after the release, and the end of operation (about 120 min after release, T5) respectively. ECG was observed. The levels of serum isoenzyme of lactate dehydrogenase (LDH1), creatine kinase (CK), MB isoenzyme of CK (CK-MB), malondialdehyde (MDA), and the activity of superoxide dismutase (SOD), nitric oxide (NO), nitric oxide synthetase (NOS) were determined. Pieces of pathologic myocardium tissue were taken from the two groups after the operation and ultrastructure were observed under electric microscope. Results: Compared with the control group, the treated group could alleviate ultrastructure injury, reduce myocardial enzymes' release and the content of MDA, improve the activity of SOD, NO and NOS (P<0.05). Conclusions:The pathomechanism of MIRI: Heart Qi vacuity is the root, heart blood stasis obstruction and internal turbid toxin formation are the tip. The therapeutic principles are:Boosting Qi and nourishing heart, activating blood circulation and resolving toxin, treating the root and tip simultaneously. Huxinbao could protect ischemic myocardium and MIRI significantly.