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目的:观察血管内皮活性因子一氧化氮(NO)和内皮素-1(ET-1)在止血带诱发肺换气功能损伤中的作用及参麦注射液对其的干预效果。方法:选择单侧下肢手术患者(需要上止血带)26例,按单盲法随机分为对照组(C组,n=14)和参麦注射液组(SM组,n=12)。于L2,3间隙行脊椎-硬膜外联合阻滞。SM组于上止血带15 min前将参麦注射液0.6 mL.kg-1加入100 mL生理盐水静脉滴注完毕,C组在相同时间内滴注等量的生理盐水。动态观察2组患者上止血带前(T0)、松止血带后30 min(T1),2 h(T2),6 h(T3),24 h(T4)5个时点血气指标及血NO和ET-1的浓度变化。结果:与T0时比较,C组T3时动脉血氧分压、血NO浓度降低,肺泡-动脉血氧分压差和血ET-1浓度升高(P<0.05,P<0.01);SM组T3时血NO浓度降低(P<0.05),各时点血气指标和血ET-1浓度比较差异无统计学意义。与C组比较,SM组松止血带后的动脉血氧分压和血NO浓度降低幅度减慢,肺泡-动脉血氧分压差、血ET-1浓度升高幅度降低(P<0.05)。结论:NO和ET-1参与止血带诱发的肺换气功能损伤过程,参麦注射液有改善肺换气功能,其机制可能与参麦注射液有提高NO、降低ET-1水平有关。
Objective: To observe the role of vascular endothelial activator nitric oxide (NO) and endothelin-1 (ET-1) in the tourniquet-induced pulmonary ventilation injury and the effects of Shenmai injection on them. Methods: Twenty-six patients with unilateral lower extremity surgery (upper tourniquet required) were randomly divided into control group (C group, n = 14) and Shenmai injection group (SM group, n = 12). Spinal - epidural block in the L2,3 space. SM group in the tourniquet 15 min before the Shenmai injection 0.6 mL.kg-1 added 100 mL of saline intravenously, C group at the same time instillation of the same amount of saline. The blood gas indexes and blood levels of NO and NO in the two groups were observed before the tourniquet (T0), 30 min (T1), 2 h (T2), 6 h (T3) and 24 h Changes in the concentration of ET-1. Results Compared with T0, arterial partial pressure of oxygen and blood NO decreased, alveolar-arterial partial pressure of oxygen and blood ET-1 increased (P <0.05, P <0.01) in group C at T3, T3 blood concentration decreased (P <0.05), at each time point blood gas and blood ET-1 concentration was no significant difference. Compared with group C, the decrease of arterial partial pressure of oxygen and concentration of blood NO in SM group was slower than that in group C, the difference of alveolar-arterial partial pressure of oxygen and blood ET-1 decreased (P <0.05). CONCLUSION: NO and ET-1 are involved in tourniquet-induced pulmonary ventilation injury. Shenmai injection may improve pulmonary ventilation, and its mechanism may be related to the increase of NO and ET-1 level in Shenmai injection.