黄芪预处理对心脏瓣膜置换术心肌保护作用的临床研究

目的探讨黄芪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30例心脏瓣膜置换术患者随机分为试验组和对照组,两组灌注方法及体外循环方法相同.试验组在转机前于预充液中加入黄芪注射液20 ml.分别于主动脉阻断前、开放多时点采血检测心肌酶CK-MB、cTnI的水平;记录两组患者的体外循环时间、主动脉阻断时间及术中、术后各时点血管活性药物多巴胺的用量及心肌收缩能力(dp/dtmax)恢复情况;观察开放后心脏自动复跳率、室性心律失常发生率等心肌电生理指标;电镜观察手术前、后心肌超微结构变化.结果对照组术后室性心律失常发生率、除颤次数明显高于试验组;试验组缺血再灌注后心肌收缩能力(dp/dtmax)恢复情况优于对照组.开放后6 h、12 h血清心肌酶CK-MB水平对照组和试验组分别为(91.6±20.4)U/L和(52.7±17.3)U/L,(148.7±24.2)U/L和(94.3±16.3)U/L;开放后6 h、12 h血清cTnI水平对照组和试验组分别为(4.973±1.431)ng/ml和(2.622±1.024)ng/ml,(5.054±1.419)ng/ml和(1.908±0.984)ng/ml,对照组明显高于试验组(P＜0.05或P＜0.01).试验组心肌超微结构保存较好,损伤较对照组轻.结论黄芪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.

Myocardial protective effect of astragalus during heart valve replacement surgery

Objective To evaluate the myocardial protective effect of astragalus during heart valve replacement surgery. Methods Thirty patients required heart valve replacement were divided randomly into two groups: astragalus group(n=15)and control group(n=15). CPB was set up routinely and cold cardioplegia was perfused. astragalus(20 ml) was administered in astragalus group before CPB. Creatine kinase-MB and cardiac troponin-I were measured. A series of clinical data were recorded, such as the incidence of spontaneous recovery of heart beat after aorta off-clamping, ventricular arrhythmia, myocardial constriction (dp/dtmax), the CPB time, cross-clamp time and supplementary circulation time. Myocardial ultrastructure changes in two groups were assessed. Results The serum CK-MB and cTnI levels in control group were much higher than those of astragalus group. The myocardial ultrastructure in astragalus group was significantly less damaged than that in the control group. The clininical indexes such as supplementary time, incidence of ventricular arrhythmia in astragalus group was much lower than that of control group. Conclusion Astragalus can offer protective effect on myocardium during heart valve replacement surgery.