细胞间黏附分子-1在体外循环肺损伤中的作用及参麦注射液的干预效果

目的：观察细胞间黏附分子-1（ICAM-1）在体外循环肺损伤中的作用，探讨参麦注射液（SM）肺保护的作用机制。方法：选择心脏瓣膜置换术患者30例，随机分为对照组和观察组，各15例，观察组在体外循环（CPB）转机前将参麦注射液0．6ml／kg加入250ml生理盐水静脉滴注完毕，对照组在同一时间予生理盐水250ml静脉滴注，其余麻醉维持方法两组相同。分别于麻醉诱导前（T0）、CPB停机后0．5小时（T1）、2小时（T2）、6小时（耶）、24小时（T4），取桡动脉血进行血气分析，记录P02、PC02、Fi02，计算肺泡-动脉血氧分压差P（A-a）D02]以及呼吸指数（RI），并留取血清测定细胞间黏附分子-1（ICAM-1）浓度，同时记录CPB时间和主动脉阻断时间。结果：P（A—a）DO2、RI、ICAM-1在体外循环停机后明显升高（P〈0．05或P〈0．01）；与对照组比较，观察组此三项指标均明显降低（P〈0．05或P〈0．01）。结论：ICAM-1的高低与体外循环肺损伤程度密切相关；参麦注射液可能通过抑制细胞间黏附分子-1的分泌而起到肺保护作用。

Intercellular Adhesion Molecule-1 in Lung Injury of Cardiaopulmonary Bypass and the Protective Effect of Shenmai Injection

Objective： To observe the influence of Shenmai injection on intercellular adhesion molecule - 1 （ ICAM - 1 ） in lung injury by eardiopulmonary bypass （CPB） and to explore the underlying mechanism of the protective effect of Shenmai injection on organ damage. Methods： Thirty patients undergoing open heart surgery under CPB for cardiac valve replacement were randomized into a treatment group intravenously infused by physiological saline 250 ml with 0.6 ml/kg Shenmai injection and a control group by physiological saline 250 ml alone, 15 patients each. Other anesthesia procedures remained the same in the 2 groups. Blood samples were taken from radial artery before the induction of anesthesia and at 0.5, 2, 6, 24 hours after terminating CPB for blood gas analysis and serum ICAM-1 determination. Results： In both groups, alveolar-arterial oxygen difference, respiratory index, and the level of ICAM-1 showed no difference before anesthesia but all increased after terminating CPB （ P 〈 0.05 or P 〈 0.01 ）. Compared to the control group, these indexes were reduced in the treatment group（ P 〈0.05 or P 〈 0.01 ）. Conclusion ： Shenmai injection has protective effects on lung injury induced by CPB through inhibiting ICAM-1.