【摘要】 目的：探讨黄芪注射液配伍川芎嗪防治体外循环心内直视手术中心肌缺血再灌注损伤（ＭＩＲＩ）的作用机理，并探讨ＭＩＲＩ的中医病机、治则。方法：风湿性心脏病瓣膜置换术和先天性心脏病室间隔修补术患者２４例，随机分为对照组、黄芪注射液组（益气组）川芎嗪组（活血组）、黄芪注射液配伍川芎嗪组（益气活血组）各６例。术中动态监测心电；分别在麻醉前（Ｔ１）、主动脉阻断１０ｍｉｎ（Ｔ２）、主动脉开放１０ｍｉｎ（Ｔ３）、３０ｍｉｎ（Ｔ４）、手术结束（约主动脉开放１８０ｍｉｎ，Ｔ５）经锁骨下中心静脉取血。测定血清谷草转氨酶（ＡＳＴ）、肌酸磷酸激酶（ＣＫ）、肌酸磷酸激酶同工酶（ＣＫ－ＭＢ）、乳酸脱氢酶（ＬＤＨ）、丙二醛（ＭＤＡ）含量、超氧化物歧化酶（ＳＯＤ）活力、一氧化氮（ＮＯ）和一氧化氮合成酶（ＮＯＳ）活性。结果：治疗各组与对照组比较，可减轻心肌酶、ＭＤＡ和ＳＯＤ变化，益气活血组最明显，与对照组比较多数有显著性差异（Ｐ＜０．０５，Ｐ＜０．０１）。益气组（Ｔ５）和益气活血组（Ｔ４、Ｔ５）ＮＯ活力高于对照组（Ｐ＜０．０５）。结论：ＭＩＲＩ中医辨证，病位在心，证属气虚血瘀，其治则是益气活血。黄芪注射液配伍川芎嗪注射液对其有良好的保护作用，优?更多还原

【Abstract】 To investigate the mechanism of Astragalus injection plus ligustrazine in preventing the occurrence of myocardial ischemia reperfusion injury (MIRI) during open heart surgery of cardiopulmonary bypass, and the treating principle of MIRI in TCM. Methods: Twenty-four patients suffering from either valvular heart diseases or congenital ventricular septal defect were randomly divided into three treated groups (Astragalus, ligustrazine, Astragalus plus ligustrazine) and the control group, 6 in each group. Blood samples were taken via subclavian central vein at the time before anesthesia (T,1), 10 minutes of occlusion of aorta (T2), 10 minutes (T3) and 30 minutes (T4) after the release, and the end of operation (about 180 minutes after release, T5) respectively; EKG was observed, and the levels of aspartate aminotransferase (AST), lactate dehydrogenase (LDH), creatine kinase (CK), MB isoenzyme of CK (CK-MB), malondialdehyde (MDA) and the activity of superoxide dismutase (SOD), nitric oxide (NO), nitric oxide synthetase (NOS) were determined. Results: The treated groups could reduce the levels of AST, LDH, CK, CK-MB, MDA, SOD compared with the control group, particularly Astragalus plus ligustrazine, there had significant difference (P < 0. 05, P< 0. 01). In NO activity improvement, Astragalus plus ligustrazine won the best effect, Astragalus group the next. Conclusions: The mechanism of MIRI is Qi deficiency and blood stasis in TCM, its treating principles should be promoting Qi and removing the blood stasis. According to the authors’ study, Astragalus plus ligustrazine could effectively protect against MIRI, which is better than using the 2 medicines separately.更多还原