CAJ | 학술논문

目的探讨黄芪注射液对体外循环(CPB)下行心脏瓣膜置换术患者脑血糖的利用和乳酸的影响.方法 30例择期行心脏瓣膜置换术患者,随机分为:黄苠注射液组(A组)和对照组(B组),每组15例.两组的麻醉方法均相同,A组麻醉诱导后将黄芪注射液20ml加入100 ml生理盐水中静脉滴注,B组静脉滴注等容积生理盐水.分别于给药前(T1),CPB降温至鼻温33℃(T2),主动脉阻断15分钟(T3),CPB复温至鼻温33℃(T4),CPB结束后0.5小时(T5)以及CPB结束后2小时(T6),测定桡动脉和颈静脉球部血糖浓度差[G(a-v)],颈静脉球部的乳酸含量(Lac).结果两组患者体外循环时间、主动脉阻断时间、手术时间无明显差异,与T1相比,两组T2、T3、T5、T6各时间点上G(a-v)差异有显著性(P＜0.05),而在T3,T6点上A组显著高于B组(P＜0.05),两组Lac在CPB开始后其浓度逐渐升高,T5点达到高峰,在T4、T5、T6点上A组均显著低于B组(P＜0.05).结论静脉注射黄芪注射液可提高体外循环下行心脏瓣膜手术患者对葡萄糖的利用,增加脑的能量供应,减少乳酸的生成.
목적 탐토황기주사액대체외순배(CPB)하행심장판막치환술환자뇌혈당적이용화유산적영향.방법 30례택기행심장판막치환술환자,수궤분위:황민주사액조(A조)화대조조(B조),매조15례.량조적마취방법 균상동,A조마취유도후장황기주사액20ml가입100 ml생리염수중정맥적주,B조정맥적주등용적생리염수.분별우급약전(T1),CPB강온지비온33℃(T2),주동맥조단15분종(T3),CPB복온지비온33℃(T4),CPB결속후0.5소시(T5)이급CPB결속후2소시(T6),측정뇨동맥화경정맥구부혈당농도차[G(a-v)],경정맥구부적유산함량(Lac).결과 량조환자체외순배시간、주동맥조단시간、수술시간무명현차이,여T1상비,량조T2、T3、T5、T6각시간점상G(a-v)차이유현저성(P＜0.05),이재T3,T6점상A조현저고우B조(P＜0.05),량조Lac재CPB개시후기농도축점승고,T5점체도고봉,재T4、T5、T6점상A조균현저저우B조(P＜0.05).결론 정맥주사황기주사액가제고체외순배하행심장판막수술환자대포도당적이용,증가뇌적능량공응,감소유산적생성.
Objective To investigate the effects of astragalus injection on cerebral glucose metabolism and lactate concentration in patients undergoing cardiac valve replacement with cardiopulmonary bypass (CPB). Methods 30 patients scheduled for valve replacement were randomly divided into two groups: astragalus injection group ( group A ) and control group ( group B). Anesthesia induction and maintenance were same in two groups. In group A, astragalus injection 20ml was given i.v. after induction of anesthesia. In group B normal saline was given instead of astragalus injection. The blood samples were collected from jugular bulb before injection(T1), at the moment of 33℃ cooling(T2),stable hypothermic duration ( T3 ), 33℃ rewarming(T4),0.5 h(T5),2 h ( T6 ) after CPB for determination of arterial and jugular bulb blood glucose, utilization of glucose[G (a-v)] and extraction of lactate ( Lac ). Results At points ofT2, T3, T5, T6 G (a-v) in two groups was markedly lower than those at T1 ( P＜0.05 ). At points of T3, T6 G( a-v) was significantly higher in group A than that in group B ( P＜0.05 ).The level of Lac increased after beginning of CPB and reached peak value at T5. At points of T4, T5, T6, The level of Lac was significantly lower in group A than that in group B (P＜0.05 ).Conclusion Astragalus injection may improve cerebral glucose utilization ,and decrease the extraction of lactate.