川芎嗪对先心病肺动脉高压影响作用的研究

目的探讨川芎嗪对先心病肺动脉高压的影响。方法选取先天性心脏病45例。其中中、重度肺动脉高压30例;肺动脉压正常15例。分为川芎嗪治疗组(A组,n=15)及对照组(B组,n=15)。肺动脉压正常者为空白对照组(C组,n=15)。围术期不同时点测定血浆中ET1、NO、cAMP、cGMP含量,治疗组于用药前及术中测定肺动脉压。结果①A组及B组各时点血浆ET1含量明显高于C组,NO、cAMP、cGMP含量明显低于C组,差异均有显著性(P<0.01)。②A组术前1d及术后72h血浆ET1含量分别低于用药前及术后24h,NO、cAMP、cGMP含量分别高于用药前及术后24h,差异有显著性(P<0.01)。③A组及B组比较:用药前及术后24h血浆中各因子含量无明显变化(P>0.05)。A组术后72h血浆ET1的含量明显下降,cGMP含量明显升高,差异有显著性(P<0.01);NO及cAMP含量无明显变化(P>0.05)。结论川芎嗪降低血浆中ET1的含量,增加NO、cAMP及cGMP的含量,提示川芎嗪可降低肺动脉张力及肺动脉压力,减少围术期肺动脉高压危象的发生率,提高手术的成功率。

A study on the role of tetramethylpyrazine on pulmonary hypertension secondary to congenital heart disease

Objective To study protective action of tet ramethylpy razine on endothelial cells of pneumoangiogram and pulmonary artery pressure. Methods 30 patients diagnosed with congenital heart defect associated complicated with moderate and severe PH were randomly divided into the tetram ethylpyrazine group (group A,n=15) and the control group (group B,n=15). 15 patients without PH were used as blank control group (group C,n=15). We measured the pulmonary artery pressure (PAP) before medication and on operation in group A and the concentrations of endothelin-1(ET-1),nitric oxide (NO),cAMP and cGMP in perioperative period. Results In both groups A and B the concentration of ET-1 was higher than that in group C (P<0.01), but the concentrations of NO,cAMP and cGMP were lower in groups A and B than group C (P<0.01). After treating PH with tetramethylpyrazine, compared with group B, plasma ET-1 level decreased and plasma NO,cAMP,cGMP levels increased and in group A this difference was significant before operation. Conclusion Tetramethylpyrazine decreases plasma ET-1 level and increases plasma NO, cAMP, cGMP levels. It reduces the tension and pressure of pulmonary artery, decreases the incidence of pulmonary hypertension crisis in perioperative period and rise the success rate of operation.