人工瓣膜置换体外循环过程中痰热清注射液的肺保护

背景：体外循环心内直视术不可避免会造成肺损伤,近年来临床上已有中医药应用于该领域减轻肺损伤的研究。目的：观察痰热清注射液对机械瓣置换患者体外循环肺损伤的保护效果。方法：心脏瓣膜置换患者40例随机分为2组,痰热清组患者于术前晚、体外循环前分别予以痰热清注射液20mL入250mL生理盐水静脉滴注,对照组予以生理盐水250mL静滴。于体外循环前、体外循环40min、体外循环停机、停机后2,6,24h共6个不同时间点抽取桡动脉血2mL,全血细胞分析仪测定中性粒细胞数量;双抗体夹心ELISA法测定可溶性细胞间黏附因子1、白细胞介素8血浆浓度。并于体外循环前、体外循环停机时取左右心房血测中性粒细胞并计算跨肺差值。于瓣膜置换切皮前、体外循环结束后10min、瓣膜置换结束时、瓣膜置换结束后4h4个时相计算两组患者的呼吸指数与肺动态顺应性。结果与结论：两组患者体外循环后各个时间点中性粒细胞值、可溶性细胞黏附因子1、白细胞介素8较体外循环前明显升高（P〈0.01）,痰热清组明显低于对照组（P〈0.01）。体外循环停机时中性粒细胞跨肺差值明显高于体外循环前（P〈0.01）,痰热清组明显低于对照组（P〈0.01）。两组呼吸指数较瓣膜置换切皮前明显升高（P〈0.01）,肺动态顺应性较体外循环前明显降低（P〈0.01）,瓣膜置换结束后4h恢复至切皮前水平（P〉0.05）,痰热清组呼吸指数较对照组降低（P〈0.05）,肺动态顺应性瓣膜置换结束时较对照组升高（P〈0.01）。提示痰热清注射液能减轻机械瓣置换后的肺损伤,有较好的肺保护效果。

Protective effect of Tanreqing injection on the lung during heart valve replacement

BACKGROUND： Cardiopulmonary bypass for open heart surgery can cause acute lung injury, and there are many reports on the traditional Chinese medicine in reducing lung injury. OBJECTIVE： To evaluate the protective effect of Tanreqing injection on acute lung injury during cardiopulmonary bypass in patients undergoing heart valve replacement. METHODS： A total of 40 patients undergoing heart valve replacement were randomly divided into Tanreqing group and control group （20 in each group）. In Tanreqing group, intravenous drip of 20 mL of Tanreqing injection mixed with 250 mL normal saline was given the night before operation and prior to cardiopulmonary bypass, respectively, while in the control group, intravenous drip of 250 mL normal saline was given. Serial blood samples of radial artery were collected at the following intervals： prior to cardiopulmonary bypass, 40 minutes after cardiopulmonary bypass and 0, 2, 6 and 24 hours after the end of cardiopulmonary bypass. Then the amount of neutrophil was measured with hematology analyzer; the serum levels of soluble intercellular adhesion molecule-1 and interleukin-8 was detected with double-antibody sandwich enzyme linked immunosorbent assay methods. Neutrophil ratio of right and left atrium cordis （transpulmonary polymorphonuclear） was calculated before cardiopulmonary bypass and immediately after the end of cardiopulmonary bypass, and the transpulmonary difference was calculated. We also calculated pulmonary dynamic compliance and respiratory indexes before valve replacement and skin incision, 10 minutes after the termination of cardiopulmonary bypass, at the end of surgery and 4 hours after the end of surgery, respectively. RESULTS AND CONCLUSION： The amount of neutrophil, intercellular adhesion molecule-1, interleukin-8 at different time points after cardiopulmonary bypass were significantly higher than those before cardiopulmonary bypass （P 0.01）, but levels of those in Tanreqing group were significantly lower than those in the control group （P 0.01）. The transpulmonary difference at the end of cardiopulmonary bypass was significantly higher than that before cardiopulmonary bypass （P 0.01）, and the transpulmonary difference in the Tanreqing group was significantly lower than that in the control group （P 0.01）. The respiratory indexes of the two groups were increased compared with those before valve replacement and skin incision （P 0.01）. The pulmonary dynamic compliance of the two groups was significantly decreased compared with that before cardiopulmonary bypass （P 0.01）, and then returned to the level before skin incision at 4 hours after the end of valve replacement. The respiratory index in the Tanreqing group was lower than that in the control group （P 0.05）. The pulmonary dynamic compliance after valve replacement in the Tanreqing group was higher than that in the control group （P 0.01）. Tanreqing injection can reduce the lung injury after valve replacement and protect the lung.