丹红注射液对体外循环下冠状动脉搭桥术患者脑损伤的保护作用

目的探讨丹红注射液对体外循环(CPB)下冠状动脉搭桥术患者脑损伤的保护作用及机制。方法50例择期体外循环下冠状动脉搭桥术患者,随机分为丹红注射液组(简称丹红组)和对照组,每组25例。丹红组给予丹红注射液,分别于预充和开放主动脉时泵入,剂量为1.5mL/kg;对照组给予等容积生理盐水。两组患者分别于手术前(T1)、复温至36℃(T2)、停CPB后30min(T3)、CPB后6h(T4)抽取颈静脉球血,于T1-4各时点用黄嘌呤氧化酶法测定超氧化物歧化酶(SOD)活性,用硫代巴比妥法测定丙二醛(MDA)浓度,用放免法测定肿瘤细胞坏死因子-α(TNF-α)水平、白细胞介素6、8(IL-6、8)浓度,并用ELISA法测定IL-10浓度。结果与T1比较,T2-4两组MDA浓度均明显升高(P<0.01),而对照组SOD活性显著降低(P<0.01);丹红组SOD活性明显高于对照组(P<0.05,P<0.01),而MDA浓度则显著低于对照组(P<0.05)。两组患者TNF-α、IL-6、IL-8及IL-10浓度在T3,T4比T1明显升高(P<0.01),而丹红组TNF-α、IL-6、IL-8浓度在T3,T4显著低于对照组(P<0.05,P<0.01),IL-10浓度则在T4明显高于对照组(P<0.01)。两组患者术中生命体征平稳,均无不良反应发生。结论丹红注射液对体外循环下冠状动脉搭桥术患者脑损伤具有明显的保护作用,其机制可能与其抗炎、抗氧化及调节免疫因子的表达有关。

英文摘要:

Objective To investigate the effect and its possible mechanisms of Danhong Injection(DHI)on cerebral injury during coronary artery bypass graft(CABG)operation with hypothermic cardiopulmonary bypass(CPB).Methods Fifty patients went to CABG with CPB were randomly assigned equally to two groups,the control group and the tested group.DHI 1.5 mL/kg was pumped to where the tested group at the times of aortic pre-charging and unclamping respectively,but to the control group,equal volume of normal saline was given instead.Blood samples were taken from jugular bulb at different time points,i.e.before operation(T1,baseline),re-warming to 36℃(T2),30 min(T3)and 6 h(T4)after terminating CPB,for determination levels of superoxide dismutase(SOD)activity using xanthine oxidase method,malondialdehyde(MDA)concentration using thiobarbituric method,tumor necrosis factor α(TNF-α),as well as interleukin-6,-8 using radioimmunoassay and-10(IL-6,IL-8 and IL-10)using ELISA.Results Level of SOD activity significantly decreased during(T2)and after CPB(T3 and T4)in the control group,as compared to the T1(P<0.01),but it was unchanged in the tested group;level of MDA increased during and after CPB in both groups(P<0.01),but more significantly in the control group(P<0.05),so comparison after CPB between the two groups showed a higher SOD and lower MDA level in the tested group.Plasma levels of TNF-α,IL-6,IL-8 and IL-10 significantly increased in both groups after CPB(T3 and T4,P<0.01)as compared to the T1,but the comparison between groups showed lower plasma TNF-α,IL-6 and IL-8 levels at T3 and T4,and higher IL-10 level at T4 in the test group(P<0.01).All patients had stable life signs with no occurrence of adverse reaction.Conclusion DHI has obvious protective effect on cerebral injury in patients undergoing CABG with CPB,the mechanisms may be associated with the actions of anti-oxidation,anti-inflammation and regulation on immune factors.

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