【作者】 张军；

【导师】 张健； 徐瑞好；

【作者基本信息】 安徽医科大学 ， 麻醉学， 2009， 硕士

【摘要】 体外循环心脏直视手术是治疗心肌脏疾病的常见方法,但其存在着缺血再灌注损伤现象,并由此产生一系列较严重的并发症,因此,如何有效的降低缺血再灌注损伤是十分重要的。参附注射液源于祖国医学参附汤的中药配方,大量的临床实验和应用表明其在外科手术中的应用是安全有效性,但围术期应用是否有积极作用尚未见报道。目的研究参附注射液对心肌线粒体及其细胞损伤的影响。方法30例行二尖瓣/主动脉瓣置换术(MVR/AVR)患者随机分为观察组(n=15)和对照组(n=15),观察组在对照组治疗方法的基础上术前5天静滴参附注射液1.5ml/kg·d,并在手术当日麻醉诱导前再次滴入1.5ml/kg。对照组按围术期常规对症支持处理。两组患者在升主动脉阻断前、开放后10分钟、30分钟从冠状静脉窦取血测定丙二醛(MDA)、超氧化物岐酶(SOD)、心肌钙蛋白(cTnI)含量;并于升主动脉阻断前、开放后10分钟、30分钟、2、24、48小时从中心静脉取血测CK-MB、LDH水平,电镜观察两组患者心肌超微结构变化,并行线粒体Flameng分级。结果1、两组患者MDA、SOD、cTnI的情况升主动脉阻断前两组患者MDA、SOD、cTnI含量差异无统计学意义(P>0.05)。观察组MDA、cTnI、CK-MB、LDH在升主动脉开放后均低于同时段的对照组(P<0.05或P<0.01)。2、两组患者升主动脉开放后CK-MB、LDH水平先上升并在24h达到峰值随后逐渐下降,但对照组多个时点比观察组明显升高。3、心肌细胞线粒体形态改变比对照组显著减轻。4、血流动力学变化平均动脉压变化主动脉开放后各组表现下降趋势(P<0.05),组间比较,观察组比对照组MAP平稳(P<0.05)。心率变化各组在主动脉开放后心率比术前明显增加(P<0.05),但观察组比较对照组心率有所减慢(P<0.05)。中心静脉压变化心脏复跳后观察组中心静脉压较对照组降低,有较显著差异性(P<0.05)。结论围术期应用参附注射液可减轻心肌缺血再灌注损伤,对心肌细胞具有一定的保护作用。更多还原

【Abstract】 Open heart surgery with cardiopulmonary bypass is very common operation in treating heart diease. But it lead to ischemia reperfusion injury, and have a lot of serious complication. The prevention of ischemia reperfusion injury is very important , which consists of reduction of surgical time and new techniques. Shenfu injection is from Chinese medicine, which has excellent ereat efficacity and less side-effects. Using shenfu injection during periopration to prevent ischemia reperfusion injury hasn’t been reported. This experiment tries to supply the gap.Objective To investigate The effect of shenfu injection on myocardium of ultrastructure and cell injury during periopration.Methods 30 cases scheduled for cardiac surgery were randomly divided into tow group: test group(n=15)and control group(n=15). In the test group shenfu injection was injected by intrarenous drip for 1.5ml/kg·d. In the control group the treatment was common. Blood samples were withdrawn from coronary venous sinus before cross-damping and 10minutes、30minutes after aorta dedamping to measure the levels of the content of malondialdehyed (MDA)、superoxide dismutase(SOD) and the serum cardinl troponin I(cTnI). Blood samples were collected from central vein before cross-clamping and 30minutes, 2hours, 24hours, 48hours after aorta declamping to detect creatine phosphokinase inoenzyme (CK-MB) an dlactate duhydrogenase(LDH). Myocardial ultrastructure was observed using electron microscope.Results MDA and cTnI levels in the test group were lower than those in the control group. 30minutes, 2hours, 24hours, 48hours after aorta declampingm, CK-MB and LDH were lower in the test group than the control group(P<0.05 or P<0.01). Elecrton microscope showed myocardium injury was lighted in test group than in control group. MAP was steady in test group, rather gradually increased in control group after aorta declamping. CVP and HR were steady in test group than that in control graup.Conclusion shenfu injection can protect myocardial mitochondria against ischemia-reperfusion injury in open heart operation with cardiopulmonary bypass.更多还原