甘利欣对风湿性心脏病二尖瓣置换术围术期CGRP与ET-1的影响

目的探讨甘利欣预处理对心脏手术围术期血浆降钙素基因相关肽（CGRP）、内皮素-1（ET-1）水平的影响。方法选择60例风湿性心脏病二尖瓣病变患者,ASAⅡ-Ⅲ级,择期在体外循环下行二尖瓣置换术,按随机数字表法分为甘利欣组和对照组,每组30例。麻醉诱导插管后,甘利欣组用10%葡萄糖注射液100 mL内加甘利欣2.5 mg.kg-1静脉泵入,对照组用10%葡萄糖注射液100 mL静脉泵入,2组液体均在麻醉诱导后至手术切皮前期间20 min内泵完。分别于麻醉诱导后（T1）,主动脉阻断后15 min（T2）、主动脉开放后15 min（T3）、2 h（T4）、24 h（T5）时间点取中心静脉血样,检测CGRP与ET-1水平。结果主动脉阻断后及主动脉开放后24 h内2组患者CGRP均较麻醉诱导后明显升高（P〈0.01）,甘利欣组明显高于对照组（P〈0.05）;2组ET-1主动脉阻断后均下降,T1、T2时间点2组间比较差异无统计学意义（P〉0.05）,主动脉开放后24 h内2组患者ET-1逐渐上升,T4、T5时间点均明显高于麻醉诱导后水平（P〈0.01）,主动脉开放后24 h内甘利欣组低于对照组（P〈0.05）。结论甘利欣预处理可提高心脏缺血期及再灌注期血浆CGRP及降低再灌注期血浆ET-1。

Effect of Diammonium Glycyrrhizinate Preconditioning on Calcitonin Gene-related Peptide and Endothelin-1 during Perioperative Period in Patients Undergoing Mitral Valve Replacement for Rheumatic Heart Disease

Objective To explore the effect of diammonium glycyrrhizinate preconditioning on calcitonin-gene-related peptide（CGRP） and endothelin-1（ET-1） during perioperative period in patients undergoing open heart surgery.Methods Sixty patients with rheumatic mitral valvular disease（ASAⅡ-Ⅲ） undergoing mitral valve replacement with cardiopulmonary bypass were randomly divided into diammonium glycyrrhizinate preconditioning group and control group,with 30 patients in each group.Diammonium glycyrrhizinate（2.5 mg·kg-1） dissolved in 100 mL 10% glucose solution was intravenously administered within 20 minutes between the end of anesthesia induction and the beginning of surgical incision in diammonium glycyrrhizinate preconditioning group.Control group only received intravenous glucose infusion.Blood samples were taken to detect plasma CGRP and ET-1 after anesthesia induction（T1）,15 minutes after aortic occlusion（T2）,15 minutes after reperfusion（T3）,2 hours after reperfusion（T4）,and 24 hours after reperfusion（T5）.Results The levels of CGRP increased significantly in both groups after aortic cross-clamping and during the first 24 hours after aortic unclamping（P0.01）,and the levels in diammonium glycyrrhizinate preconditioning group were significantly higher than those in control group（P0.05）.The content of ET-1 in both groups decreased after aortic cross-clamping,and no significant differences were observed between the two groups at T1 and T2（P0.05）.During 24 hours after aortic unclamping,the content of ET-1 increased gradually in the two groups,and the content at T4 and T5 was higher than that at T1,and the content in diammonium glycyrrhizinate preconditioning group was lower than that in control group（P0.01 or P0.05）.Conclusion Diammonium glycyrrhizinate preconditioning can increase plasma CGRP concentration during ischemia and reperfusion and decrease ET-1 content during reperfusion.