复方丹参注射液对心内直视手术心肌缺血再灌注后血清内皮素及前列环素/血栓素A2比值的影响

目的：观察复方丹参注射液对心内直视手术心肌缺血再灌注后血清内皮素（ET），前列环素（PGI2），血栓素A2（TXA2）及PGI2/TXA2比值的影响。方法：20例先天性室间隔缺损或房间隔缺损患者随机分为治疗组（10例）及对照组（10例）。治疗组于手术开始前及复温后心脏复跳前分别静脉注射复方丹参注射液200mg/kg，对照组给予等容量平衡盐深液。经中心静脉取血测定ET、PGI2及TXA2含量。并计算PGI2/TXA2比值。结果：在体外循环开始（T1）后两组血清ET显著降低（P<0.05），PGI2及TXA2显著增加(P<0.05）。心肌缺血再灌注后对照组ET进行性增加，从再灌注后30min(T3)～24h(T5)均显著高于治疗组（P<0.05）。再灌注期间治疗组PGI2及TXA2降低速度比对照组快，但治疗组PGI2/TXA2比值高于对照组。T5时治疗组PGI2及TXA2含量显著低于对照组（P<0.05），但PGI2/TXA2比值高于对照组（P<0.05）。血清ET含量与PGI2/TXA2比值呈显著负相关(r=-0.822,P<0.05）。治疗组患者术后心功能的恢复优于对照组。结论：复方丹参注射液能升高再灌注期PGI2/TXA2比值，有效抑制再灌注期内皮素的产生，促进缺血再灌注心脏功能的恢复。

Effects of Salvia Miltiorrhiza Compound Injection on Serum Endothelin, Prostaglandin I2/Thromboxane A2 Ratio Alteration Following Myocardial Ischemia-Reperfusion in Patients Undergoing Intracardiac Surgery

OBJECTIVE: To investigate the effects of Salvia miltiorrhiza compound injection (SMCI) on serum endothelin (ET), prostaglandin I2(PGI2), thromboxane A2(TXA2), and PGI2/TXA2 ratio following myocardial ischemia-reperfusion in patients undergoing intracardiac surgery. METHODS: Twenty patients, scheduled for selective surgery, were randomly divided into the SMCI group (group A, 10 cases) and the control group (group B, 10 cases). SMCI 200 mg/kg was given intravenously in group A before starting the operation and at the time of rewarming respectively, and equivalent volumes of normal saline were administered to group B. The central venous blood samples were collected to measure the serum concentration of ET, PGI2, TXA2, and PGI2/TXA2 ratio. RESULTS: ET significantly reduced, while PGI2 and TXA2 obviously raised in both groups at the beginning (T1) of extracorporeal cardiopulmonary bypass (CPB) (P < 0.05). After cardiac ischemia-reperfusion, ET in group B increased rapidly and significantly (P < 0.05) and evidently higher than the corresponding value in group A 30 min after reperfusion (T3) till 24 hrs after reperfusion (T5). During reperfusion, PGI2 and TXA2 in group A decreased more rapidly than that of group B, while group A maintained higher PGI2/TXA2 ratio than that of group B. At T5, PGI2 and TXA2 in group A were significantly lower than those in group B, while PGI2/TXA2 ratio was higher than that in group B (P < 0.05). The serum ET level was obviously negatively correlated to PGI2/TXA2 ratio. The postoperative cardiac function recovered much better in group A than in that group B. CONCLUSION: SMCI can significantly reduce serum ET level, raise PGI2/TXA2 ratio, thus facilitate the postoperative cardiac function recovery following intracardiac surgery under CPB.