参脉注射液对心脏瓣膜置换术的心肌保护作用

目的探讨参脉注射液(SMI)在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40例心脏瓣膜置换术患者随机均分为参脉组(SM组)和对照组(C组),SM组在心肺转流(CPB)前静脉给予SMI,C组用等量生理盐水。分别于术前、术中、术后多时点采血,比较两组心肌磷酸激酶(CK)、磷酸激酶同工酶(CK-MB)、肌钙蛋白I(cTnI)、丙二醛(MDA)、超氧化物歧化酶(SOD)水平;记录两组患者的手术时间、主动脉阻断时间及术中、术后各时点血管活性药物的用量,观察主动脉开放后心脏自动复跳率、室性心律失常发生率。结果SM组血清CK、CK-MB、cTnI、MDA等指标均低于C组(P<0.05),而两组SOD活性均降低,但SM组明显高于C组(P<0.05)。SM组室性心律失常发生率、除颤次数及血管活性药物的用量明显低于C组(P<0.01)。结论SMI对心脏瓣膜置换术患者心肌缺血-再灌注损伤具有明显保护作用。

Effects of shenmai injection on myocardial protection in patients undergoing heart valve replacement surgery

Objective To evaluate the myocardial protective effect of shenmai during heart valve replacement surgery under cardiopulmonary bypass (CPB).Methods Forty patients undergoing heart valve replacement were divided randomly into group SMI (n=20)and group C (n=20). Shenmai injection 0.5 ml/kg was administered in group SMI before CPB. Blood samples were withdrawn before skin incision,during and after operation for detecting the serum levels of creatine kinase(CK),creatine kinase-MB(CK-MB ),cardiac troponin-I(cTnI),malondialdehyde (MDA) and superoxide dismutase(SOD) . Clinical data including the time of operation and the occlusion, the incidence of spontaneous recovery of heart beat after aorta unclamping and that of ventricular arrhythmia were recorded. Results The serum CK,CK-MB,cTnI and MDA levels in group SMI were lower than those in group C (P<0.05).Serum level of SOD in both groups was decreased compared with that before, which was higher in group SMI than that in group C (P<0.05). The clininical indexes such as the incidence of ventricular arrhythmia in group SMI was much lower than that of group C (P<0.01). Conclusion SMI can offer protective effect on myocardium during heart valve replacement surgery.