体外循环炎症反应中粘附分子变化及干预性治疗的研究

目的探讨体外循环(CPB)围术期中药川芎嗪干预性治疗的作用机制及临床意义.方法选取诊断明确的先天性心脏病病人32例,随机分成川芎嗪组20例,对照组12例.前者在体外循环预充液中加入盐酸川芎嗪5 mg/kg,后者不用.分别于麻醉诱导后,转机15 min,停机2、6、12、24 h共6个时点,抽取动脉血,采用双抗体夹心法酶联免疫吸附试验测定血浆中可溶性细胞间粘附分子(sICAM-1)、可溶性P-选择素(sP-Selectin)的表达值.结果麻醉诱导后(基值)川芎嗪组和对照组sICAM-1、sP-Selectin无明显差异(P＞0.05);转机后15 min、停机2、6、12 h两组的sICAM-1、sP-Selectin表达值均明显升高,其中停机6、12 h最为明显,与基值比较 ,差异有显著性(P＜0.05);但川芎嗪组较对照组为低(P＜0.05).结论川芎嗪能减弱CPB致炎症反应中sICAM-1、sP-Selectin表达,减轻CPB所致炎症反应,从而减少CPB下心脏直视手术并发症的发生.

The effects of changes in adhesion molecules on inflammatory response to cardiopulmonary bypass

Objective: To explore the characteristics of cell adhesion molecules (sICAM-1, sP-selectin) changes on inflammatory response during cardiopulmonary bypass, and observe the effect of intervention therapy with ligustrazine on changes of cell adhesion molecules. Methods: 32 cases of congenital heart disease were divided at random into ligustrazine group (20 cases) and control group (12 cases). Ligustrazine (5mg/kg) were added to extracorporeal circulation machine in ligustrazine group. In each group, arterial blood samples were taken at the following time-points after induction of anesthesia, 15 minutes after the start of CPB, and 2 hours, 6 hours, 12 hours, 24 hours after CPB. sICAM-1, sP-selection was measured by double antibodies sandwich enzyme-linked immunosorbent assay (ELISA). Results: Plasma levels of both adhesion molecules in both groups at baseline were in normal ranges. After CPB, levels of adhesion molecules were significantly increased in both groups. The plasma levels of sICAM-1, sP-selectin in control group were higher than in ligustrazine group (P<0.01). Conclusion: The plasma levels of sICAM-1, sP-selectin were significantly increased during inflammatory response. Ligustrazine can weaken the expression of soluble ICAM-1, Soluble P-selectin and ameliorate the inflammatory response to CPB.