参附注射液预先给药对体外循环下瓣膜置换术患者心肌的保护作用

目的 探讨参附注射液预先给药对体外循环下瓣膜置换术患者心肌的保护作用.方法 择期体外循环下拟行瓣膜置换术的患者30例,年龄18～51岁,体重45～73kg,ASAⅡ或Ⅲ级,心功能Ⅱ或Ⅲ级,随机分为2组(n=15),对照组(C组)和参附注射液预先给药组(SH组).SH组于术前5 d静脉输注参附注射液1.5 ml/kg,1次/d,连续5 d,麻醉诱导前30 min再次静脉输注参附注射液1.5 ml/kg,参附注射液均溶于5%葡萄糖溶液或生理盐水250 ml中;C组不输注参附注射液,余治疗同SH组.于主动脉阻断前即刻(T_1)、主动脉开放后10 min(T_2)、30 min(T_3)、2 h(T_4)、24 h(T_5)、48 h(T_6)时取右侧颈内静脉血样2 ml,采用免疫抑制法测定血浆肌酸激酶同工酶(CK-MB)及乳酸脱氢酶(LDH)的活性;于T_(1～3)时取冠状静脉窦血样2 ml,分别测定血浆丙二醛(MDA)、心肌肌钙蛋白I(cTnI)的浓度及超氧化物歧化酶(SOD)活性;于主动脉阻断前即刻及开放后即刻取右心房全层心肌组织,电镜下观察心肌细胞线粒体超微结构.记录心脏自动复跳情况、血管活性药物使用情况及主动脉阻断时间.结果 与T_1时比较,两组T_(2,3)时血浆cTnI和MDA浓度升高,T_(2～6)时CK-MB及LDH活性升高,T_(2,3)时SOD活性降低(P<0.05或0.01);与C组比较,SH组T_(2,3)时血浆cTnI和MDA浓度降低,T_(2～6)时CK-MB和LDH活性降低,多巴胺和硝酸甘油用量明显减少,T_(2,3)时血浆SOD活性及心脏自动复跳率明显升高(P<0.05或0.01).SH组心肌细胞线粒体病理损伤程度较C组明显减轻.结论 体外循环下瓣膜置换术患者参附注射液预先给药可产生一定程度的心肌保护作用,其机制可能与抑制脂质过氧化反应有关.

Protective effect of Shenfu injectio pretreatment on myocardium in patients undergoing cardiac valve replacement with cardiopulmonary bypass

Objective To investigate the protective effect of Shenfu injectio (SFI) pretreatment on myocardium in patients undergoing cardiac valve replacement with cardiopulmonary bypass (CPB). Methods Thirty ASA Ⅱ or Ⅲ patients with cardiac function Ⅱ or Ⅲ, aged 18-51 yr, weighing 45-73 kg, scheduled for elective cardiac valve replacement under CPB, were randomly divided into 2 groups (n = 15 each): control group and SFI group. In SFI group, shenfu injectio 1.5 ml/kg (dissolved in 5% glucose or normal saline) was infused iv once a day for 5 days before operation and then infused again for 30 min before anesthesia induction. In control group, shenfu injectio was not given and the other procedures were the same as those in SFI group. Venous blood samples were drawn immediately before aortic clamping (T_1), and at 10 min (T_2), 30 min (T_3), 2 h (T_4), 24 h (T_5) and 48 h (T_6) after aortic unclamping for determination of plasma CK-MB and LDH activities. Blood samples were taken from coronary sinus at T_(1-3) for determination of plasma MDA and cardiac troponin I (cTnI) concentrations, and SOD activity. Myocardial tissues of right ventricle were taken at T_1 and immediately after aortic unclamping to observe the myocardial ultrastructure (using electron microscope). The rate of spontaneous heart beat, consumption of vasoactive drugs, and aortic clamping time were recorded. Results Plasma cTnI and MDA concentrations at T_(2,3), and CK-MB and LDH activities at T_(2-6) were significantly increased and SOD activity at T_(2,3) was significantly decreased compared with those at T_1 in two groups (P < 0.05 or 0.01). Plasma cTnl and MDA concentrations at T_(2,3), and CK-MB and LDH activities at T_(2-6) and consumption of dopamine and nitroglycerin were significantly lower and SOD activity at T_(2,3) and rate of spontaneous heart beat significantly higher in SFI group than in control group (P < 0.05 or 0.01). Microscopic examination showed that the injury to mitochondrial ultrastructure was attenuated in SFI group compared with control group. Conclusion Shenfu injectio can protect myocardium in patients undergoing cardiac valve replacement with CPB to some extent and the mechanism may be related to inhibition of lipid peroxidation.