体外循环下痰热清对瓣膜置换术中肺损伤的保护作用的临床观察

目的观察体外循环下瓣膜置换围术期应用痰热清对肺的保护作用,从而为体外循环下瓣膜置换术药物应用于肺保护提供一条更好的途径。方法选择30例择期行心脏瓣膜置换术的心脏病患者随机分为对照组（C）、痰热清组（T）,每组15例。痰热清组患者术前晚给予痰热清射液葡萄糖注射液静脉滴注1次,于切皮前相同方法再次给予以上等量药物1次;对照组给予氯化钠注射液。两组患者分别麻醉诱导后即切皮前（T1）、体外循环45min（T2）、体外循环停机前5min（T3）停机后6h时（T4）停机后24h（T5）5个时间点,即刻对T1-T3送动脉血检测中性粒细胞（PMN）值,用硫代巴比妥酸比色法检测T1-T3时点血浆丙二醛（MDA）浓度,并用ELISA法测定T1-T5时点血浆肿瘤坏死因子α（TNF-α）浓度。结果痰热清组T2-T5时点的TNF-α血清浓度较对照组相同时点的浓度差异有统计学意义（P〈0.05）;痰热清组T2-T3时点的MDA血清浓度及PMN值较对照组相同时点的浓度差异有统计学意义（P〈0.05）。结论心脏瓣膜置换术CPB期间促炎细胞因子TNF-α、脂质过氧化产物MDA及PMN释放增加;痰热清注射液可以明显降低血清细胞因子TNF-α、脂质过氧化产物MDA和PNM的生成,起到保护肺的作用。

Observation of protective role of the lung injury after using Tanreqing injection during cardiopulmonary bypass in patients undergoing heart valve replacement

Objective To observe the protective role of the lung injury after using Tanreqing injection during perioperation of heart valve replacement undergoing cardio pulmonary bypass（CPB）,and the inflammatory inhibition of the response for the drug,so as to provide a better way for the lung protection during CPB.Methods 30 patients undergoing valve replacement were randomly divided into control group and Tanreqing group（15 in each group）.In Tanreqing group,intravenous drip of 20 ml of Tanreqing injection plus 5% glucose injection 500 ml were given at night before operation and before CPB,while in control group 0.9% NaC1 solution was given as a placebo.Serial blood samples were respectively collected at the following intervals： After anesthesia induction（T1）,45min after CPB（T2）,5min before the end of CPB（T3） and 6h（T4）,24h（T5） after the end of CPB.We measured the serum levels of TNF-α by Elisa method at the time T1-T5,the malondialdehyde（MDA） by thiobarbituricacid chromatometry and instantly detect the polymorpho-nuclear leucocyte in the blood at the time T1-T3.Results The serum levels of TNF-α after CPB were significantly higher than that before CPB（P0.01）.The serum levels of TNF-α gradually increased after the beginning of CPB.The serum levels of TNF-α in Tanreqing group was significantly lower than that in control group（P0.05） at the time points of T2-T5.The serum levels of MDA and the PMN in Tanreqing group was significantly lower than that in control group（P0.05） at the time points of T2-T3.Conclusion The study demonstrates that there are increases of serum TNF-α,MDA and the PMN during CPB in patients undergoing valve replacement.Tanreqing injection could reduce the release of TNF-α,lipid peroxidation（MDA） and the PMN,and relieve the degree of injury of lungs during CPB.