CAJ | 학술논문

　　背景：目前国内外对于适合未成熟心肌停搏液的研究均未取得突破性进展，通过添加成分来提高现有停搏液对未成熟心肌的保护可能是一个较好的手段。腺苷能减轻缺血和中性粒细胞介导的再灌注损伤；丹参能降低缺血心肌脂质过氧化物含量，增加心肌细胞对氧自由基的清除。目的：探讨添加腺苷和丹参的改良心肌保护液对心脏、肝脏、肾脏的保护作用。方法：60例首次心内直视手术婴幼儿随机分为3组，各20例，腺苷组采用改良心肌保护液添加腺苷，联合组采用改良心肌保护液添加腺苷和丹参，对照组采用等容量的改良心肌保护液。于麻醉诱导前、体外循环开始后30 min、体外循环结束后30 min及体外循环结束后24 h采集患儿血标本，检测血清肌酸激酶同工酶、谷丙转氨酶、谷草转氨酶、尿素氮、肌酐、肿瘤坏死因子α、白细胞介素6、白细胞介素8、白细胞介素10水平变化。结果与结论：3组患儿血清谷丙转氨酶、谷草转氨酶、尿素氮、肌酐、肌酸激酶同工酶均有升高，但是对照组升高最明显(P<0.01)，腺苷组和联合组比较差异有显著性意义(P<0.05)；肿瘤坏死因子α、白细胞介素6，白细胞介素8水平均比术前显著升高(P<0.05)。对照组肿瘤坏死因子α、白细胞介素6、白细胞介素8明显高于诱导前以及相同时点腺苷组和联合组的水平(P <0.01)；体外循环结束后30 min及24 h，3组白细胞介素10水平均明显增高，但腺苷组和联合组明显高于对照组(P <0.01)。提示改良心肌保护液对未成熟心肌有良好的保护作用，能明显降低心内直视手术患儿血浆肿瘤坏死因子α、白细胞介素6、白细胞介素8水平，促进抑制炎细胞因子白细胞介素10的分泌，有效降低由体外循环引发的炎症反应，对心、肺、肝、肾等重要脏器有保护作用。
　　배경：목전국내외대우괄합미성숙심기정박액적연구균미취득돌파성진전，통과첨가성분래제고현유정박액대미성숙심기적보호가능시일개교호적수단。선감능감경결혈화중성립세포개도적재관주손상；단삼능강저결혈심기지질과양화물함량，증가심기세포대양자유기적청제。목적：탐토첨가선감화단삼적개양심기보호액대심장、간장、신장적보호작용。방법：60례수차심내직시수술영유인수궤분위3조，각20례，선감조채용개양심기보호액첨가선감，연합조채용개양심기보호액첨가선감화단삼，대조조채용등용량적개양심기보호액。우마취유도전、체외순배개시후30 min、체외순배결속후30 min급체외순배결속후24 h채집환인혈표본，검측혈청기산격매동공매、곡병전안매、곡초전안매、뇨소담、기항、종류배사인자α、백세포개소6、백세포개소8、백세포개소10수평변화。결과여결론：3조환인혈청곡병전안매、곡초전안매、뇨소담、기항、기산격매동공매균유승고，단시대조조승고최명현(P<0.01)，선감조화연합조비교차이유현저성의의(P<0.05)；종류배사인자α、백세포개소6，백세포개소8수평균비술전현저승고(P<0.05)。대조조종류배사인자α、백세포개소6、백세포개소8명현고우유도전이급상동시점선감조화연합조적수평(P <0.01)；체외순배결속후30 min급24 h，3조백세포개소10수평균명현증고，단선감조화연합조명현고우대조조(P <0.01)。제시개양심기보호액대미성숙심기유량호적보호작용，능명현강저심내직시수술환인혈장종류배사인자α、백세포개소6、백세포개소8수평，촉진억제염세포인자백세포개소10적분비，유효강저유체외순배인발적염증반응，대심、폐、간、신등중요장기유보호작용。
BACKGROUND:The research at home and abroad for appropriate immature myocardial cardioplegia has no breakthrough, and it may be a better mean to improve the protection effect of existing cardioplegia on immature myocardial by adding ingredients. Adenosine can reduce ischemia and neutrophil-mediated reperfusion injury, and salvia miltiorrhiza can reduce the content of ischemic myocardial lipid peroxide and increase the scavenging of myocardial cells to oxygen radical. OBJECTIVE:To investigate the protection effect of improved myocardial protection fluid containing adenosine and salvia miltiorrhiza on the heart, liver and kidney. METHODS:Sixty cases of infant open heart operation of the first time were randomly divided into three groups, 20 cases in each group. The adenosine group received the improved myocardial protection fluid added with adenosine, the combination group received the improved myocardial protection fluid added with adenosine and miltiorrhiza salvia, and the control group received the improved myocardial protection fluid in the same volume. The blood samples were taken at the time before anesthesia induction, 30 minutes after cardio pulmonary bypass beginning, 1 hour after cardio pulmonary bypass end and 24 hours after cardio pulmonary bypass end. The serum levels of the creatine kinase, alanine aminotransferase, aspartate aminotransferase, blood urea nitrogen, creatinine, tumor necrosis factor-α, interleukin-6, interleukin-8 and interleukin 10 were detected. RESULTS AND CONCLUSION:The serum levels of the alanine aminotransferase, aspartate aminotransferase, blood urea nitrogen, creatinine and creatine kinase in three groups were increased, but the control group was increased significantly (P<0.01), and there were significant differences between adenosine group and combination group (P<0.05);the levels of tumor necrosis factor-α, interleukin-6 and interleukin-8 were significantly increased after operation (P<0.05). The levels of tumor necrosis factor-α, interleukin-6 and interleukin-8 in the control group were significantly higher than those in the adenosine group and combination group before induction and at the same time point (P<0.01);at 3 minutes and 24 hours after cardio pulmonary bypass, the level of interleukin-10 was increased in three groups, but the level of interleukin-10 in the adenosine group was significantly higher than that in the control group (P<0.01). The results indicate that improved myocardial protection fluid has great protection effect on immature myocardial, and can significantly reduce the serum levels of tumor necrosis factor-α, interleukin-6 and interleukin-8, promote the secretion of interleukin-10 that can inhibit inflammatory cytokine and can significantly reduce the inflammatory response caused by cardiopulmonary bypass. So the improved myocardial protection fluid has protection effect on important organs, such as heart, lung, liver and kidney.