摘要
目的 观察血必净注射液对Stanford B型主动脉夹层（AD）患者腔内修复术后炎症细胞因子的影响,并探讨其临床意义.方法 选择2014年1月至2016年6月湖南中医药大学第一附属医院心胸血管外科收治的Stanford B型AD行腔内修复术患者60例,将患者按随机数字表法分为血必净组和对照组,每组30例.血必净组术中给予以血必净注射液100 mL＋生理盐水50 mL静脉滴注（滴注）,对照组给予等量生理盐水,均每日2次,连续治疗3 d.于术前和术后1、2、3 d采集外周静脉血,用酶联免疫吸附试验（ELISA）检测血液中C-反应蛋白（CRP）、肿瘤坏死因子-α（TNF-α）、白细胞介素-6（IL-6）含量,并观察两组预后情况.结果 随着时间延长,两组术后CRP、TNF-α、IL-6水平均表现出先升高后降低的趋势,与术前比较,两组术后上述指标均明显升高,CRP（mg/L）、TNF-α（ng/L）均于术后2 d达峰值（对照组：CRP为146.34±13.92,TNF-α为72.22±7.63;血必净组：CRP为114.92±9.89,TNF-α为53.44±6.80）,IL-6（ng/L）于术后1 d达峰值（对照组为146.08±10.29,血必净组为117.88±8.84）,随后下降,均于术后3 d达到谷值（对照组CRP、TNF-α、IL-6分别为112.59±8.54、43.73±4.10、70.03±4.66,血必净组CRP、TNF-α、IL-6分别为87.75±7.67、39.43±4.63、56.65±3.27）,且同一时间点血必净组CRP、TNF-α、IL-6均明显低于对照组,以术后3 d的变化最显著〔CRP（mg/L）：87.75±7.67比112.59±8.54,TNF-α（ng/L）：39.43±4.63比43.73±4.10,IL-6（ng/L）：56.65±3.27比70.03±4.66,均P〈0.05〕.两组术后均未出现肾衰竭、严重低氧血症、感染、截瘫、支架移位等严重并发症,无院内死亡病例,均康复出院.结论 Stanford B型AD腔内修复术后患者炎症反应被激活,表现为大量炎症因子释放,血必净注射液能抑制炎症反应,预防术后并发症的发生.
Objective To investigate the effect of Xuebijing injection on inflammatory factors in patients with Stanford B aortic dissection （AD） after endovascular repair and approach its clinical significance.Methods Sixty patients with Stanford type B AD for endovascular repair admitted to the Department of Cardiothoracic Surgery of the First Affiliated Hospital of Hunan University of Traditional Chinese Medicine （TCM） from January 2014 to June 2016 were enrolled, and they were divided into a Xuebijing group and a control group according to the random number table method, 30 cases in each group. The patients of Xuebijing group received 100 mL Xuebijing injection＋ 50 mL normal saline intravenous drip during operation, while the patients of control group received an equal volume of normal saline, 2 times a day in both groups for consecutive 3 days. Peripheral venous blood was collected before and after treatment for 1, 2, and 3 days, and the levels of C-reactive protein （CRP）, tumor necrosis factor-α（TNF-α）, interleukin-6 （IL-6） were measured by enzyme-linked immunosorbent assay （ELISA）, and the prognosis of the two groups was observed.Results With the prolongation of time, the postoperative levels of CRP, TNF-α and IL-6 in the two groups showed a tendency of first increase and then decrease compared with the preoperative levels, the above indexes of the two groups were all significantly higher, CRP （mg/L） and TNF-α （ng/L） peaked on the 2nd day postoperatively （control group： CRP was 146.34±13.92 and TNF-α was 72.22±7.63, Xuebijing group： CRP was 114.92±9.89 and TNF-α was 53.44±6.80, allP 〈 0.05）, however, IL-6 （ng/L） peaked on the 1st day postoperatively （control group： 146.08±10.29, Xuebijing group： 117.88±8.84）, then decreased, all reached the valley on the 3rd day postoperatively （control group： CRP, TNF-α, IL-6 was 112.59±8.54, 43.73±4.10, 70.03±4.66 respectively, Xuebijing group CRP, TNF-α, IL-6 was 87.75±7.67, 39.43±4.63, 56.65±3.27, respectively）, and at the same time point, the level of CRP, TNF-α, IL-6 in the Xuebijing group were significant lower than those in the control group, the change were the most significant on 3 days after operation [CRP （mg/L）： 87.75±7.67 vs. 112.59±8.54, TNF-α （ng/L）： 39.43±4.63 vs. 43.73±4.10, IL-6 （ng/L）： 56.65±3.27 vs. 70.03±4.66, P 〈 0.05]. There were no serious complications such as renal failure, severe hypoxemia, infection, paraplegia, stent shift and so on, no hospital death occurred and all patients were discharged in rehabilitative condition. Conclusions Endovascular repair in patients with Stanford type BAD may activate an inflammatory response inducing the release of a large amount of inflammatory factors during the early postoperative period, Xuebijing injection can inhibit the inflammatory reaction and prevent the occurrence of postoperative complications.
出处
《中国中西医结合急救杂志》
CAS
CSCD
北大核心
2017年第4期389-392,共4页
Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care
基金
湖南省中医药科研计划项目（201696）
中医内科学省部共建教育部重点实验室开放基金支助项目（ZYNK201506）
关键词
主动脉夹层
腔内修复术
血必净注射液
炎症因子
Aortic dissection
Endovascular repair
Xuebijing injection
Inflammatory factors
