参附注射液对心脏手术心肺转流期间胃肠道的影响

目的观察参附注射液(SF)对心脏手术病人心肺转流(CPB)期间胃肠道粘膜灌注、氧合及屏障功能的影响,并探讨其可能机制。方法择期心内直视手术病人30例,随机均分为SF组和对照组。SF组于切皮时静注SF0·5ml/kg,再取1·0ml/kg用生理盐水稀释成100ml,用Grasby泵以0·004ml·kg-1·min-1速度持续注入;对照组则输入等量生理盐水。分别于切皮前(S0)、主动脉开放1h(R1)、2h(R2)后测定胃粘膜pH(i-pH)、血浆二胺氧化酶(DAO)、血浆内毒素(LPS)水平。结果S0时两组病人胃i-pH及血浆DAO、LPS水平比较无显著性差异(P>0·05),R1和R2时的胃i-pH显著低于S0(P<0·01),DAO、LPS水平显著高于S0(P<0·01)。SF组R1和R2时的胃i-pH显著高于对照组(P<0·01),血浆DAO、LPS水平显著低于对照组(P<0·01),血浆DAO、LPS水平与胃i-pH显著负相关(P<0·01)。结论心脏手术病人CPB期间预防性的应用SF,可以改善胃肠粘膜灌注和氧合,减轻肠粘膜上皮细胞损伤,保护粘膜屏障功能。

The gastrointestinal effect of shen-fu injection in patients undergoing heart surgery during cardiopulmonary bypass

Objective To observe the gastrointestinal effect of shen-fu injection (SF) in ~patients undergoing heart surgery during cardiopulmonary bypass and study it's mechanism. Methods~Thirty patients undergoing selective heart surgery were divided into a control group and a SF group ~randomly. The patients in SF group were treated with SF 0.5 ml/kg by intravenous injection, ~1.0 ml/kg infused by Grasby pump, and those in the control group normal saline was given instead of SF. Gastric intramucosal pH value (i-pH),blood DAO and blood LPS were measured before CPB, at 1 h after artery was opened(R_1), 2 h after artery was opened(R_2). ~Results In both groups, i-pH was lower at R_1 and R_2 than that at S_0 significantly, and blood DAO and blood LPS were higher than those at S_0 significantly. In SF group, i-pH at R_1, R_2 was higher than that in control group significantly~(P<0.01).Blood DAO and blood LPS at R_1, R_2 were lower in SF group than those in control group significantly(P<0.01). The increase in blood DAO and LPS was highly negatively correlated with the decrease of i-pH(P<0.01). The increase in blood LPS was highly positively correlated with the increase in blood DAO(P<0.01). Conclusion In patients undergoing heart surgery during cardiopulmonary bypass, SF can improve gastrointestinal mucosal perfusion, protect mucosal structure and barrier function.