参附注射液对体外循环术中患者红细胞免疫功能的影响

目的观察参附注射液对体外循环(cardiopulmonary bypass,CPB)期间红细胞免疫功能的影响。方法 20例心脏瓣膜置换术患者随机分为参附注射液组(治疗组)和对照组,每组各10例。治疗组在麻醉诱导前静脉滴注参附注射液1mL/kg,在预充液中加入参附注射液1mL/kg;对照组相同时间点给予等量生理盐水。两组病例均分别于麻醉诱导前(T1)、CPB30min(T2)、CPB结束即刻(T3)、术后24h(T4)采集静脉血5mL,检测患者红细胞受体花环率(RBC-C3bRR)、红细胞免疫复合物花环率(RBC-ICR)、血浆丙二醛(MDA)、游离血红蛋白(FHB)、白细胞介素-6(IL-6)浓度的变化情况。结果两组患者RBC-C3bRR、RBC-ICR、血浆MDA、FHB、IL-6浓度T1时间点差异无统计学意义(P>0.05)。其他时间点两组患者RBC-C3bRR均较麻醉诱导前降低,除治疗组T4时间点FHB、IL-6与T1时间点比较差异无统计学意义外,其他时间点两组患者RBC-ICR、MDA、FHB、IL-6均较麻醉诱导前升高,差异均有统计学意义(P<0.05);治疗组T2-4时间点RBC-C3bRR高于对照组,RBC-ICR、MDA、FHB、IL-6低于对照组,差异均有统计学意义(P<0.05)。结论参附注射液能减少CPB期间炎症介质的产生,改善CPB中红细胞的免疫功能,减轻术后发生感染的风险。

英文摘要:

Objective To observe the effect of Shenfu Injection(SFI) on erythrocyte immunity function of patients undergoing cardiopulmonary bypass(CPB) . Methods Twenty patients scheduled for valve replacement were randomly assigned to two groups,i.e.,the SFI group and the control group,10 in each. SFI 1 mL/kg was intravenously dripped before induction of anesthesia and SFI 1 mL/kg administered in priming solution in the SFI group,while only normal saline was given to those in the control group. Venous blood samples(5 mL) were collected before induction of anesthesia(T1) ,30 min CPB(T2) ,immediate by the end of CPB(T3) ,and postoperative 24 h(T4) respectively in all groups. The levels of the rosette rate of RBC-C3b receptor(RBC-C3bRR) ,the rosette rate of RBC-immune complex(RBC-ICR) ,plasma malondialdehyde(MDA) ,free hemoglobin(FHB) ,and interleukin-6(IL-6) were detected. Results There was no significant difference in the levels of RBC-C3bRR,RBC-ICR,plasma MDA,FHB,and IL-6 at T1 in both groups(P>0.05) . RBC-C3bRR at the rest time points was lower in the two groups than before induction of anesthesia. There was no statistical difference in FHB or IL-6 between T4 and T1 in the SFI group. The levels of RBC-ICR,MDA,FHB,and IL-6 increased in the two groups more than before induction of anesthesia at T2-4(P<0.05) . Besides,the RBC-C3bRR was lower,and levels of RBC-ICR,MDA,FHB,and IL-6 higher in the control group than in the SFI group,showing significant difference(P<0.05) . Conclusion SFI could decrease the generation of inflammatory mediators during CPB,improve the erythrocyte immune function of patients during CPB,and reduce the risk of postoperative infection.

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