目的 探讨血必净注射液(XBJ)对体外循环(CPB)所致急性肺损伤的保护作用及可能的机制.方法 50例风湿性心脏病需行二尖瓣置换术的患者随机分为实验组(XBJ组)和对照组(C组),每组25例.XBJ组在切皮后CPB前静脉输注血必净注射液100 mL,对照组静脉输注相同剂量生理盐水.分别于CPB前(T0)、主动脉开放30 min(T1)、术毕(T2)、术后6 h(T3)、术后24 h(T4)测定患者血清肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)及超氧化物歧化酶(SOD),同时记录呼吸参数并行动脉血气分析计算各时间点的呼吸指数(RI)和氧合指数(OI).结果 CPB前两组患者血清TNF-α、IL-6、SOD及呼吸参数比较差异无统计学意义(P均>0.05).CPB开始后各时间点两组患者IL-6、TNF-α浓度逐步升高,但实验组低于对照组[IL-6(ng/L):42.60±1.20比44.51±1.82、76.29±2.49比86.00±3.47、56.88±10.67比69.52±3.07、49.64±2.98比63.15±3.17,均P<0.05;TNF-α(ng/L):133.88±6.14比146.60±9.41、234.99±9.73比257.71±12.36、203.92±7.56比224.28±7.60、156.53±5.67比197.60±5.15,均P<0.05].与CPB前比较,两组患者SOD浓度下降,但实验组高于对照组[SOD(U/mL):127.54±6.12比118.55±7.85、55.42±2.80比42.46±1.83、73.06±3.01比52.21±2.13、82.83±2.48比60.42±3.15,均P<0.05].而两组患者各时间点氧合指数较CPB前下降,但实验组高于对照组(431.40±35.06比412.48±21.68、387.78±27.27比291.32±15.99、418.69±25.13比323.43±34.31、397.46±20.85比333.40±23.31,均P<0.05);两组患者各时间点呼吸指数较CPB前升高,但实验组低于对照组(0.59±0.05比0.67±0.10、0.71±0.07比0.76±0.08、0.61±0.04比0.65±0.06、0.57±0.07比0.60±0.08,均P<0.05).结论 血必净注射液可以减轻CPB导致的急性肺损伤,具有肺保护作用,其作用机制可能与抑制炎症反应和减轻氧化应激有关.%Objective To investigate the pulmonary protection of Xuebijing injection in patients undergoing open heart surgery. Methods Fifty patients with rheumatic heart disease undergoing mitral valve replacement were randomly divided into two groups: experimental group (XBJ group n=25) re-ceived 100 mL Xuebijing injection intravenously for before CPB and equal volume normal saline was used instead of XBJ in control group(C group n=25). Interleukin(IL-6), TNF-αand SOD were respective-ly measured at five different time intervals including before CPB, thirty minutes after release of the aortic Cross-clamp (T1), post-operation (T2), 6 h after operation (T3), 24 h after operation (T4). Arterial blood gas was analyzed at the same time and the oxygenation index and respiratory index were calculated. Results TNF-α, IL-6 and SOD concentration before CPB(T0)was not significant different between the two groups (P>0.05). But the concentration of TNF-α and IL-6 after CPB was significantly lower than that in C group at any time point[for IL-6:(42.60 ± 1.20)vs.(44.51 ± 1.82)ng/L,(76.29 ± 2.49)vs.(86.00 ± 3.47)ng/L,(56.88 ± 10.67)vs.(69.52 ± 3.07)ng/L,(49.64 ± 2.98)vs.(63.15 ± 3.17) ng/L, P<0.05 for all;for TNF-α:(133.88±6.14)vs.(146.60±9.41)ng/L,(234.99±9.73)vs.(257.71± 12.36)ng/L,(203.92±7.56)vs.(224.28±7.60)ng/L,(156.53±5.67)vs.(197.60±5.15)ng/L, P<0.05 for all];but SOD concentration in T1~T4 was obviously higher than that in C group[for SOD:(127.54± 6.12)vs.(118.55±7.85)U/mL,(55.42±2.80)vs.(42.46±1.83)U/mL,(73.06±3.01)vs.(52.21±2.13) U/mL,(82.83±2.48)vs.(60.42±3.15)U/mL, P<0.05 for all]. The RI and OI of two groups was consis-tent before CPB, while the RI of two groups in T1~T4 are increased significantly and the RI of XBJ group was significantly lower than that of C group, but the OI of two groups in T1~T4 was reduced and the OI of XBJ group in T1~T4 was significantly higher than that of C group[for RI:(0.59±0.05)vs.(0.67±0.10), (0.71±0.07)vs.(0.76±0.08),(0.61±0.04)vs.(0.65±0.06),(0.57±0.07)vs.(0.60±0.08), P<0.05 for all;for OI:(431.40±35.06)vs.(412.48±21.68),(387.78±27.27)vs.(291.32±15.99),(418.69±25.13) vs.(323.43 ± 34.31),(397.46 ± 20.85)vs.(333.40 ± 23.31), P<0.05 for all]. Conclusion Xuebijing injection could reduce the lung injury induced by CPB and has the role of lung protection, whose mecha-nism may be associated with the alleviation of oxidative stress and inflammation reaction.
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