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目的探讨体外循环(CPB)脑损伤的发生机制及银杏叶提取物(GBE)的干预作用。方法选择44例需CPB下手术的风湿性心脏瓣膜病患者,随机分为观察组和对照组各22例。观察组在CPB预充液中加入GBE(2mg/kg体质量),对照组应用常规预充液。分别在术前、主动脉阻断后1 h、术后6、12、24、48 h抽取静脉血标本,检测血清IL-10、IL-18和S100蛋白水平。结果观察组血清IL-10在术后6 h开始升高,至术后48 h达高峰,且显著高于对照组(P<0.05)。观察组血清IL-18主动脉阻断1 h高于对照组(P<0.05),但术后6、12、24、48 h显著低于对照组(P均<0.05)。对照组S100蛋白自CPB结束开始升高,持续至实验结束;自主动脉阻断1 h开始至术后48h血清S100蛋白水平对照组均显著高于观察组(P均<0.05)。结论CPB心脏直视手术细胞因子IL-18参与脑组织损伤过程,GBE可调节细胞因子,显著减轻CPB引起的脑损伤。
Objective To investigate the mechanism of brain injury induced by cardiopulmonary bypass (CPB) and the intervention of Ginkgo biloba extract (GBE). Methods Forty-four patients with rheumatic valvular heart disease who required surgery under CPB were randomly divided into observation group and control group. The observation group added GBE (2 mg/kg body weight) to the CPB priming solution, and the control group used a conventional priming solution. Venous blood samples were collected before surgery, 1 h after aortic occlusion, and 6, 12, 24, and 48 h after surgery to detect serum IL-10, IL-18, and S100 protein levels. Results Serum IL-10 in the observation group began to increase at 6 h postoperatively and peaked at 48 h postoperatively, which was significantly higher than that in the control group (P<0.05). The serum IL-18 aortic blockade in the observation group was higher than that in the control group at 1 hour (P<0.05), but it was significantly lower at 6, 12, 24, and 48 hours after operation (P<0.05). The S100 protein in the control group began to increase from the end of CPB and continued until the end of the experiment. The serum S100 protein levels in the control group from the 1st h to the 48h after the aortic artery occlusion were significantly higher than those in the observation group (P<0.05). Conclusion The cytokine IL-18 in the open heart surgery of CPB is involved in the process of brain injury. GBE can regulate the cytokines and significantly reduce the brain damage caused by CPB.