Xia Zhong-yuan, Liu Xian-yi, Zhan Li-ying, He Yi-hong, Luo Tao, Xia Zhengyuan
Anesthesiology Research Laboratory, Renmin Hosital, Wuhan University, People's Republic of China.
J Thorac Cardiovasc Surg. 2005 Aug;130(2):258-64. doi: 10.1016/j.jtcvs.2005.02.046.
This study was undertaken to demonstrate that gastrointestinal mucosal injury occurs during cardiopulmonary bypass in children, increasing systemic inflammatory responses, and to determine whether shen-fu injection (the major components of which are ginsenosides compound, extract of Panax ginseng shown to have antioxidant properties) could attenuate gastrointestinal mucosal injury and subsequent inflammatory responses.
Twenty-four children undergoing heart surgery for congenital heart defects were randomly assigned to groups C (placebo control, n = 12) and G (1.35 mg/kg ginsenosides compound intravenously before and throughout the course of cardiopulmonary bypass, n = 12). Central venous blood samples were taken before cardiopulmonary bypass and at 60 and 120 minutes after aortic declamping (reperfusion). Gastric intramucosal pH was measured by perioperative tonometry. Plasma lipid peroxidation product malondialdehyde, myocardium-specific creatine kinase isoenzyme MB activity, diamine oxidase, lipopolysaccharide, and interleukin 6 were all measured.
Significant decrease in gastric intramucosal pH and increase in plasma diamine oxidase were seen during reperfusion in group C, accompanied by increases in plasma levels of malondialdehyde, lipopolysaccharide, interleukin 6, and creatine kinase isoenzyme MB (P < .01 vs before cardiopulmonary bypass). Shen-fu injection significantly attenuated these changes (P < .05). Consequently, fewer patients in group G (2/12) than in group C (7/12) needed postoperative inotropic support. Postoperative intensive care unit stay was shorter in group G than in group C. A tight positive correlation was seen between diamine oxidase and interleukin 6 at 60 minutes after aortic declamping and between diamine oxidase and lipopolysaccharide at 120 minutes after aortic declamping (r = 0.79, P < .0001).
Ginsenosides compound may attenuate gastrointestinal injury and inhibit inflammatory response after cardiopulmonary bypass in patients with congenital heart disease.
本研究旨在证实儿童体外循环期间会发生胃肠道黏膜损伤，从而加剧全身炎症反应，并确定参附注射液（其主要成分是复方人参皂苷，人参提取物具有抗氧化特性）是否能减轻胃肠道黏膜损伤及随后的炎症反应。
24例接受先天性心脏病心脏手术的儿童被随机分为C组（安慰剂对照组，n = 12）和G组（在体外循环前及整个过程中静脉注射1.35 mg/kg复方人参皂苷，n = 12）。在体外循环前以及主动脉夹闭解除（再灌注）后60分钟和120分钟采集中心静脉血样本。通过围手术期张力测定法测量胃黏膜内pH值。检测血浆脂质过氧化产物丙二醛、心肌特异性肌酸激酶同工酶MB活性、二胺氧化酶、脂多糖和白细胞介素6。
C组在再灌注期间胃黏膜内pH值显著降低，血浆二胺氧化酶升高，同时血浆丙二醛、脂多糖、白细胞介素6和肌酸激酶同工酶MB水平升高（与体外循环前相比，P <.01）。参附注射液显著减轻了这些变化（P <.05）。因此，G组需要术后使用强心药物支持的患者（2/12）少于C组（7/12）。G组术后重症监护病房停留时间比C组短。在主动脉夹闭解除后60分钟时，二胺氧化酶与白细胞介素6之间以及在主动脉夹闭解除后120分钟时，二胺氧化酶与脂多糖之间存在紧密的正相关（r = 0.79，P <.0001）。
复方人参皂苷可能减轻先天性心脏病患者体外循环后的胃肠道损伤并抑制炎症反应。
