黄芪注射液对婴儿先天性心脏病体外循环术后肾损伤的干预作用

作者	单位
吴春	重庆医科大学附属儿童医院心胸外科
王刚	重庆医科大学附属儿童医院心胸外科
提运幸	重庆医科大学附属儿童医院心胸外科
潘征夏	重庆医科大学附属儿童医院心胸外科
李勇刚	重庆医科大学附属儿童医院心胸外科
李洪波	重庆医科大学附属儿童医院心胸外科
代江涛	重庆医科大学附属儿童医院心胸外科
安永	重庆医科大学附属儿童医院心胸外科

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中文摘要:

目的探讨黄芪注射液对婴儿先天性心脏病(先心病)体外循环(cardiopulmonary bypass,CPB)术后肾损伤的干预效果,为先心病婴儿CPB术后肾损伤的保护提供新方法。方法选取在CPB下行先心病手术的婴儿40例,随机分为试验组(20例)与对照组(20例),试验组于手术转流前在灌注液中加入黄芪注射液(2mL/kg),对照组给予等量生理盐水。分别于转流前(T1)、手术结束时(T2)、术后2h(T3)、术后6h(T4)、术后24h(T5)以ELISA法检测两组患儿血清肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)、半胱氨酸蛋白酶抑制剂C(cystatin C,CysC)和尿N-乙酰-β-D氨基葡萄糖苷酶(N-acetyl-beta-D-glucosaminidase,NAG)浓度。结果 CPB后两组CysC无明显升高(P>0.05);对照组NAG在术后均有明显升高(P<0.05),而试验组术后升高不明显(P>0.05)且明显低于对照组(P<0.05);对照组TNF-α和IL-6在术后均有显著升高(P<0.05),试验组TNF-α和IL-6在术后明显低于对照组(P<0.01)。结论 CPB可导致先心病婴儿肾小管损伤;术前应用黄芪预处理后可对肾小管功能有保护作用。

英文摘要:

Objective To study the intervention of Astragalus Injection in the kidney injury of infants with congenital heart disease after cardiopulmonary bypass,thus providing a new method for protection of the kidney injury in them. Methods Forty infants undergoing cardiac surgery with cardiopulmonary bypass were randomly assigned to the test group and the control group,twenty in each group. Astragalus Injection (at the dose of 2 mL/kg) was added in the perfusion fluid before giving to infants in the test group before bypass,while the normal saline of the same volume was added in the perfusion fluid before giving to infants in the control group (P<0.01). The concentrations of serum tumor necrosis factor-α (TNF)-α,interleukin-6 (IL-6),cystatin C (CysC),and N-acetyl-beta-D-glucosaminidase (NAG) were detected with ELISA at the following time points,i.e. before bypass (T1),by the end of the surgery (T2),2 h after surgery (T3),6 h after surgery (T4),and 24 h after surgery (T5). Results The serum CysC concentrations were not significantly higher after CPB (P>0.05). The urinary NAG level increased significantly in the control group after surgery (P<0.05),but no obvious increase of the urinary NAG level was found in the test group after surgery (P>0.05). It was obviously lower than that of the control group (P<0.05). After CPB serum TNF-α and IL-6 levels increased significantly in the control group (P<0.05),while they were lower in the test group than in the control group (P<0.01). ConclusionsCPB may result in the renal tubular injury in infants with congenital heart disease. The application of Astragalus Injection before the CPB plays a role in protecting renal tubular functions.

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