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目的研究黄芪在体外循环心脏瓣膜置换术中对心肌缺血-再灌注损伤的保护作用。方法将24例心功能Ⅱ~Ⅲ级风湿性心脏病首次择期行心内直视瓣膜置换术病人随机分成两组:黄芪组(n=12),入手术室开放静脉通路后即以黄芪注射液0.6 g/kg加入生理盐水稀释至60 ml泵入;对照组(n=12)以60 ml生理盐水泵入。在麻醉诱导后15 min(T0)、主动脉阻断前(T1)、主动脉阻断后20 min(T2)、主动脉开放后30 min(T3)、主动脉开放后2 h(T4)及术后24 h(T5)抽桡动脉血测CK、CK-MB、CTnI。结果T0时CK、CK-MB、CTnI均在正常范围内,组间差异无统计学意义(P>0.05);T2~T5各时点CK、CK-MB、CTnI均有不同程度升高:与T0相比,CK在T4、T5,CK-MB在T3~T5均有显著升高(P<0.05),组间比较黄芪组CK在T2时显著低于对照组(P<0.05);两组CTnI在T3~T5各时点较T0时升高明显,组间比较黄芪组CtnI显著低于对照组(P<0.05)。结论黄芪可降低体外循环、心内直视瓣膜术中CTnI的释放,对此类手术中心肌缺血-再灌注损伤有保护作用。
Objective To study the protective effect of astragalus on myocardial ischemia-reperfusion injury in cardiopulmonary valve replacement surgery. Methods Twenty-four patients with cardiac function II~III rheumatic heart disease who were initially electively undergoing open heart valve replacement were randomly divided into two groups: astragalus group (n=12). After entering the open venous access to the operating room, they were treated with astragalus injection. 0.6 g/kg was diluted with normal saline and pumped in 60 ml; the control group (n = 12) was pumped with 60 ml physiological saline. 15 min after induction of anesthesia (T0), before aortic occlusion (T1), 20 min after aortic occlusion (T2), 30 min after aortic opening (T3), and 2 h after aortic opening (T4) The CK, CK-MB, and CTnI were measured in twitching arteries 24 h after surgery (T5). Results The CK, CK-MB and CTnI were all within the normal range at T0. The difference between the two groups was not statistically significant (P>0.05). The CK, CK-MB and CTnI were increased at different time points from T2 to T5. Compared with T0, CK was significantly increased in T4, T5, and CK-MB in T3~T5 (P<0.05). Compared with the control group, CK in the Huangqi group was significantly lower than the control group (P<0.05). CTnI was significantly higher at T3~T5 than at T0, and CtnI was significantly lower among the groups compared with the control group (P<0.05). Conclusion Astragalus can reduce the release of CTnI during cardiopulmonary bypass and open heart surgery. It has a protective effect on myocardial ischemia-reperfusion injury in this type of surgery.