【摘要】 目的:观察参附注射液(SF)对体外循环心脏手术患者胃肠道及全身炎性反应的影响,并初步探讨其作用机制。方法:择期心内直视手术患者30例,随机分为对照组和SF组。SF组于切皮时静注SF0.5ml·kg-1,再取1.0ml·kg-1用0.9%氯化钠稀释成100ml,用Grasby泵以SF0.004ml·kg-1·min-1速度持续注入;对照组则用同样方法输入等容量0.9%氯化钠。分别于切皮前(S0)、主动脉开放1h(R1)、2h(R2)测定胃黏膜pH(pHi)、血浆二胺氧化酶(DAO)、血浆内毒素(LPS)、血清IL-6水平。结果:S0时两组患者胃pHi、DAO、LPS、IL-6水平比较无显著差异(P<0.05);R1和R2时,两组患者胃pHi值显著低于S0值(P<0.01),DAO、LPS及IL-6水平显著高于S0值(P<0.01),SF组pHi值显著高于对照组(P<0.01),DAO、LPS及IL-6水平则显著低于对照组(P<0.01)。血浆DAO、LPS及IL-6水平与pHi呈显著相关(P<0.01),血浆LPS和IL-6水平呈显著正相关(P<0.01)。结论:SF对心脏手术体外循环期间患者胃肠道具有保护作用,并可抑制全身炎性反应。其机制可能与SF可改善胃肠道黏膜的灌注和氧合、保护肠黏膜细胞结构和功能、阻止内毒素移位及炎性介质释放有关。更多还原

【Abstract】 Objective: To observe whether Shen-Fu(SF) injection exerts any protective effect on gastrointestinal and systemic inflammatory response(SIR) in patients undergoing heart surgery during cardio-pulmonary bypass and study its mechanism. Methods: 30 patients with e-lective heart surgery were divided into a control group and a SF group randomly. At the beginning of surgery, the SF group was treated with SF 0.5 ml·kg-1 by intravenous injection, then continued with SF 1.0 ml·kg-1 injected from Grasby pump. The control group was injected with normal saline in same volume. Gastric intramucosal pH value (pHi),blood diamine oxidase(DAO), blood lipopoly-saccharide (LPS) and blood IL-6 were measured before Cardio pulmonary bypass (CPB) (S0), 1 h after artery was opened (R1),2 h after artery was opened(R2). Results: At S0 .there were no significant differences in Gastric pHi,DAO,LPS and IL-6 between the two groups(P>0.05). At R1 and R2,the pHi in control group was lower than that at So significantly (P<0. 01). Blood DAO,LPS and IL-6 were higher than those at S0 significantlu(P<0.01). In SF group, pHi at R1, R2 was higer than that in control group significantly(P<0.01), blood DAO, blood LPS and IL-6 were lower than those in control group significantly(P<0.01). The increase in blood DAO, LPS and IL-6 was highly negative correlated with the decrease of pHi (P<0.01). The increase in blood LPS was highly positive correlated with the increase in blood IL-6(P<0.01). Conclusion:SF can protect gastrointestinal and inhibit SIR in patients with heart surgery during cardio-pulmonary bypass, its mechanism may be that SF can improve gastrointestinal mucosal perfusion and oxygenization, protect structure of mucosal cell and its barrier function, inhibit inflammatory mediators release.更多还原