中国组织工程研究
中國組織工程研究
중국조직공정연구
Journal of Clinical Rehabilitative Tissue Engineering Research
2013年
5期
843-850
,共8页
邵连彬%杨晓刚%杨海平%刘文利%何进喜%边虹
邵連彬%楊曉剛%楊海平%劉文利%何進喜%邊虹
소련빈%양효강%양해평%류문리%하진희%변홍
器官移植%心肺移植%心脏瓣膜%假体置入%痰热清注射液%体外循环%急性肺损伤%炎症%可溶性细胞黏附因子 1%白细胞介素 8%呼吸指数%肺动态顺应性%其他基金
器官移植%心肺移植%心髒瓣膜%假體置入%痰熱清註射液%體外循環%急性肺損傷%炎癥%可溶性細胞黏附因子 1%白細胞介素 8%呼吸指數%肺動態順應性%其他基金
기관이식%심폐이식%심장판막%가체치입%담열청주사액%체외순배%급성폐손상%염증%가용성세포점부인자 1%백세포개소 8%호흡지수%폐동태순응성%기타기금
背景:体外循环心内直视术不可避免会造成肺损伤,近年来临床上已有中医药应用于该领域减轻肺损伤的研究.目的:观察痰热清注射液对机械瓣置换患者体外循环肺损伤的保护效果.方法:心脏瓣膜置换患者40例随机分为2组,痰热清组患者于术前晚、体外循环前分别予以痰热清注射液20 mL 入250 mL 生理盐水静脉滴注,对照组予以生理盐水250 mL 静滴.于体外循环前、体外循环40 min、体外循环停机、停机后2,6,24 h 共6个不同时间点抽取桡动脉血2 mL,全血细胞分析仪测定中性粒细胞数量;双抗体夹心 ELISA 法测定可溶性细胞间黏附因子1、白细胞介素8血浆浓度.并于体外循环前、体外循环停机时取左右心房血测中性粒细胞并计算跨肺差值.于瓣膜置换切皮前、体外循环结束后10 min、瓣膜置换结束时、瓣膜置换结束后4 h 4个时相计算两组患者的呼吸指数与肺动态顺应性.结果与结论:两组患者体外循环后各个时间点中性粒细胞值、可溶性细胞黏附因子1、白细胞介素8较体外循环前明显升高(P <0.01),痰热清组明显低于对照组(P <0.01).体外循环停机时中性粒细胞跨肺差值明显高于体外循环前(P <0.01),痰热清组明显低于对照组(P <0.01).两组呼吸指数较瓣膜置换切皮前明显升高(P <0.01),肺动态顺应性较体外循环前明显降低(P <0.01),瓣膜置换结束后4 h 恢复至切皮前水平(P >0.05),痰热清组呼吸指数较对照组降低(P <0.05),肺动态顺应性瓣膜置换结束时较对照组升高(P <0.01).提示痰热清注射液能减轻机械瓣置换后的肺损伤,有较好的肺保护效果.
揹景:體外循環心內直視術不可避免會造成肺損傷,近年來臨床上已有中醫藥應用于該領域減輕肺損傷的研究.目的:觀察痰熱清註射液對機械瓣置換患者體外循環肺損傷的保護效果.方法:心髒瓣膜置換患者40例隨機分為2組,痰熱清組患者于術前晚、體外循環前分彆予以痰熱清註射液20 mL 入250 mL 生理鹽水靜脈滴註,對照組予以生理鹽水250 mL 靜滴.于體外循環前、體外循環40 min、體外循環停機、停機後2,6,24 h 共6箇不同時間點抽取橈動脈血2 mL,全血細胞分析儀測定中性粒細胞數量;雙抗體夾心 ELISA 法測定可溶性細胞間黏附因子1、白細胞介素8血漿濃度.併于體外循環前、體外循環停機時取左右心房血測中性粒細胞併計算跨肺差值.于瓣膜置換切皮前、體外循環結束後10 min、瓣膜置換結束時、瓣膜置換結束後4 h 4箇時相計算兩組患者的呼吸指數與肺動態順應性.結果與結論:兩組患者體外循環後各箇時間點中性粒細胞值、可溶性細胞黏附因子1、白細胞介素8較體外循環前明顯升高(P <0.01),痰熱清組明顯低于對照組(P <0.01).體外循環停機時中性粒細胞跨肺差值明顯高于體外循環前(P <0.01),痰熱清組明顯低于對照組(P <0.01).兩組呼吸指數較瓣膜置換切皮前明顯升高(P <0.01),肺動態順應性較體外循環前明顯降低(P <0.01),瓣膜置換結束後4 h 恢複至切皮前水平(P >0.05),痰熱清組呼吸指數較對照組降低(P <0.05),肺動態順應性瓣膜置換結束時較對照組升高(P <0.01).提示痰熱清註射液能減輕機械瓣置換後的肺損傷,有較好的肺保護效果.
배경:체외순배심내직시술불가피면회조성폐손상,근년래림상상이유중의약응용우해영역감경폐손상적연구.목적:관찰담열청주사액대궤계판치환환자체외순배폐손상적보호효과.방법:심장판막치환환자40례수궤분위2조,담열청조환자우술전만、체외순배전분별여이담열청주사액20 mL 입250 mL 생리염수정맥적주,대조조여이생리염수250 mL 정적.우체외순배전、체외순배40 min、체외순배정궤、정궤후2,6,24 h 공6개불동시간점추취뇨동맥혈2 mL,전혈세포분석의측정중성립세포수량;쌍항체협심 ELISA 법측정가용성세포간점부인자1、백세포개소8혈장농도.병우체외순배전、체외순배정궤시취좌우심방혈측중성립세포병계산과폐차치.우판막치환절피전、체외순배결속후10 min、판막치환결속시、판막치환결속후4 h 4개시상계산량조환자적호흡지수여폐동태순응성.결과여결론:량조환자체외순배후각개시간점중성립세포치、가용성세포점부인자1、백세포개소8교체외순배전명현승고(P <0.01),담열청조명현저우대조조(P <0.01).체외순배정궤시중성립세포과폐차치명현고우체외순배전(P <0.01),담열청조명현저우대조조(P <0.01).량조호흡지수교판막치환절피전명현승고(P <0.01),폐동태순응성교체외순배전명현강저(P <0.01),판막치환결속후4 h 회복지절피전수평(P >0.05),담열청조호흡지수교대조조강저(P <0.05),폐동태순응성판막치환결속시교대조조승고(P <0.01).제시담열청주사액능감경궤계판치환후적폐손상,유교호적폐보호효과.
BACKGROUND: Cardiopulmonary bypass for open heart surgery can cause acute lung injury, and there are many reports on the traditional Chinese medicine in reducing lung injury. OBJECTIVE: To evaluate the protective effect of Tanreqing injection on acute lung injury during cardiopulmonary bypass in patients undergoing heart valve replacement. METHODS: A total of 40 patients undergoing heart valve replacement were randomly divided into Tanreqing group and control group (20 in each group). In Tanreqing group, intravenous drip of 20 mL of Tanreqing injection mixed with 250 mL normal saline was given the night before operation and prior to cardiopulmonary bypass, respectively, while in the control group, intravenous drip of 250 mL normal saline was given. Serial blood samples of radial artery were col ected at the fol owing intervals: prior to cardiopulmonary bypass, 40 minutes after cardiopulmonary bypass and 0, 2, 6 and 24 hours after the end of cardiopulmonary bypass. Then the amount of neutrophil was measured with hematology analyzer; the serum levels of soluble intercel ular adhesion molecule-1 and interleukin-8 was detected with double-antibody sandwich enzyme linked immunosorbent assay methods. Neutrophil ratio of right and left atrium cordis (transpulmonary polymorphonuclear) was calculated before cardiopulmonary bypass and immediately after the end of cardiopulmonary bypass, and the transpulmonary difference was calculated. We also calculated pulmonary dynamic compliance and respiratory indexes before valve replacement and skin incision, 10 minutes after the termination of cardiopulmonary bypass, at the end of surgery and 4 hours after the end of surgery, respectively. RESULTS AND CONCLUSION: The amount of neutrophil, intercel ular adhesion molecule-1, interleukin-8 at different time points after cardiopulmonary bypass were significantly higher than those before cardiopulmonary bypass (P < 0.01), but levels of those in Tanreqing group were significantly lower than those in the control group (P < 0.01). The transpulmonary difference at the end of cardiopulmonary bypass was significantly higher than that before cardiopulmonary bypass (P < 0.01), and the transpulmonary difference in the Tanreqing group was significantly lower than that in the control group (P < 0.01). The respiratory indexes of the two groups were increased compared with those before valve replacement and skin incision (P < 0.01). The pulmonary dynamic compliance of the two groups was significantly decreased compared with that before cardiopulmonary bypass (P < 0.01), and then returned to the level before skin incision at 4 hours after the end of valve replacement. The respiratory index in the Tanreqing group was lower than that in the control group (P< 0.05). The pulmonary dynamic compliance after valve replacement in the Tanreqing group was higher than that in the control group (P < 0.01). Tanreqing injection can reduce the lung injury after valve replacement and protect the lung.
