摘要：
目的：观察芪参益气滴丸预处理对体外循环下心脏瓣膜置换手术患者的心肌保护的影响。方法选择陆军总医院2012年5月～2013年5月间满足诊断及入选标准的需在体外循环下行二尖瓣和（或）主动脉瓣瓣膜置换术患者120例，随机分成观察组和对照组各60例。术前对照组常规强心、利尿治疗基础上，应用安慰剂（与芪参益气滴丸色味相同的丸），每次0.5 g，3/d，餐后0.5 h 服用，连续7 d；观察组在常规治疗的基础上，应用芪参益气滴丸，每次0.5 g，3/d，餐后0.5 h服用，连续7 d。两组患者分别于麻醉前（T0）、手术后12 h（T12）和24 h（T24）抽血检测血清心肌损伤标志物磷酸肌酶同工酶（CK-MB）和肌钙蛋白I（cTnI），并记录手术时体外循环时间、辅助循环时间、升主动脉阻断时间，开放升主动脉后心脏自动复跳情况、体外循环停止后多巴胺用量、心律失常发生情况、术后停留监护室（ICU）时间。结果观察组中男性28例，女性32例，平均年龄（55.20±9.20）岁，对照组中男性32例，女性20例，平均年龄（57.1±10.4）岁，两组患者在病种、术式、年龄、性别、体重、术前心功能分级、麻醉方法、术中用药、术后用药比较均无明显差异（P＞0.05）。两组患者的体外循环时间、辅助循环时间、主动脉阻断时间的比较差异无统计学意义（P＞0.05）；观察组心律失常发生率低于对照组，两组患者的心律失常类型均为阵发性房颤，但在统计学上无显著差异性（P＞0.05）。手术后观察组平均多巴胺用量、开放升主动脉后心脏自动复跳情况、停留ICU时间均优于对照组，三个时间段cTnI和CK-MB浓度低于对照组（P＜0.05）。结论心脏瓣膜病患者术前常规治疗基础上加用芪参益气滴丸，可以减少心肌细胞内心肌酶的溢漏，保护因缺血再灌注受损的心肌细胞，对改善术后患者心脏功能，促进术后恢复具有重要作用。%Objective To observe the influence of Qishenyiqi Gutta Pills preconditioning on myocardial protection in patients with open-heart valve replacement.Methods The patients (n=120) accorded with diagnosis and inclusive criteria and undergone open-heart mitral valve and/or aortic valve replacements were chosen from the Chinese PLA Army General Hospital from May 2012 to May 2013, and randomly divided into observation group and control group (eachn=60). The control group was given placebo (as same as Qishenyiqi Gutta Pills in color and smell) 0.5 g/time and 3 times a day, and 0.5 h after meal for 7 d continuously on the base of conventional cardiotonic and diuretic therapies before the surgery. The observation group was given Qishenyiqi Gutta Pills 0.5 g/time and 3 times a day, and 0.5 h after meal for 7 d continuously on the base of the same therapies in the control group before the surgery. The levels of creatine phosphokinase MB (CK-MB) and cardiac troponin I (cTnI) were detected at the time points of before anesthesia (T0), 12 h after the surgery (T12) and 24 h after the surgery (T24). The time of cardiopulmonary bypass (CPB), assisted circulation time, time of ascending aortic occlusion, heart auto-rebeating situation after opening ascending aorta, dopamine dosage after stopping CPB, incidence of arrhythmia and stay time in ICU were recorded in 2 groups.Results There were 28 male cases and 32 female cases, and average age=(55.20 ±9.20) in observation group, and 32 male cases and 20 female cases, and average age=(57.1±10.4) in control group. The differences in disease, surgery, age, gender, weight, preoperative cardiac function grading, anesthesia method, medication during surgery and postoperative medication had no statistical significance between 2 groups (P>0.05). The difference in CPB time, assisted circulation time and time of aortic occlusion had no statistical significance between 2 groups (P>0.05). The incidence of arrhythmia was lower in observation group than that in control group and the type of arrhythmia was paroxysmal atrial fibrillation, but there was no significantly statistical difference between 2 group (P>0.05). The average dopamine dosage, heart auto-rebeating situation after openingascending aorta and stay time in ICU were superior in observation group to those in control group, and levels of cTnI and CK-MB were lower in observation group than those in control group at 3 time points (P<0.05).Conclusion Qishenyiqi Gutta Pills used based on preoperative conventional therapies can reduce the overflow of myocardial enzymes, protect cardiomyocytes injured by ischemic reperfusion, and improve postoperative heart function and recover in patients with heart valve disease.
