The Study Of Clinical Effect Of Xuebijing And The Influence Of Tumor Necrosis Factor-α After Cardioplumonary Bypass

Objective To evaluate whether Xuebijing can reduce the incidence of lung injury after CPB and the influence to serum TNF-alpha after using Xuebijing.Cardiopulmonary bypass(CPB) is a way to provide a kind of important assistant for heart surgeon, which making the patient get rid of the heart and the lung possible. With the developing of CPB machine and technique and the enhance of cardiac surgery, the complications and mortality rate is decreasing gradually. However, pulmonary dysfunction is still one of the complications after CPB postoperative in common clinical. Most of the patient, especially the gerontal one, will have lung dysfunction even acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) after heart surgery with cardiopulmonary bypass. So reducing the occerence of lung dysfunction can improve the prognosis of heart surgery. Patients will have benefit if the lung dysfunction decreased, but there is still lack of effective means of prevention and treatment. TNF-alpha is a kind of inflammation mediator, which is a cytokine star-up the inflammatory reaction. The simmune system The excessive release of TNF-alpha, may lead to dysfunction of the immune system, the outbreak of inflammatory reaction, resulting in systemic inflammation. The use of drugs interfers TNF-alpha activation can reduce the lung injury. Xuebijing is a intravenous formulation prevented by Professor Wangjinda according to the famous troditional Chinese medicine fomula XueFuZhuYu. Xuebijing has the effect on blood circulation to blood stasis from the view of traditional Chinese medicine and from the point of modern medicine, Xuebijing can inhibit the release of inflammation mediator. Based on a number of research results, Xuebijing can release the inflammation cykotine, which induced to improve the lung function[5][6]. It’s reported Xuebijing can decrease the lung injury after CPB on dogs[7],but there is not any research on human. This research in order to discuss whether Xuebijing can decrease the injury of lungs following cardiopulmonary bypass and the influence of TNF-a by injectiong Xuebijing.MethodsClinical prosepctive cohort study in Guangdong Province Traditional Chinese Medical Hospital, according to the simple randonmization table,50 patients who would be performed to cardioplumonary bypass were divided randomly into treatment group and control group from 2013 October to 2015 March. Control group were be treated by routine treatment including the primary disease and the complications. Treatment group were treated by routine treatment plus Xuebijing. The two groups were observed after the operation time of mechanical ventilation, record the respiratory index (RI) and oxygenation index (01) before operation,30min after coming back to CCU and before tracheal intubation. As well as the serum content of TNF-alpha before operation, lh,6h and 24h after CPB should be observed.Results1. There is no difference in RI、01、and TNF-a between the two group before operation (P>0.05).2. The serum content of TNF-alpha begin to increase after CPB and reach a peak in 6 hours, then come down slowly, but still higher than properation at 24h after CPB(P=0.00).3.30min after coming back to CCU,OI began to drop and RI began to rise, compare to the control group, the score of OI and RI are better (01:305.80 ± 10.38 vs 269.88 ± 17.44, RI:2.16 ± 0.18 vs 2.59±0.18). But there no difference between the two group before removing the endotracheal intubation.4. The time of mechanical ventilation is lesser (25.6 ± 26.96 vs 66.3 ± 91.52).ConclusionXuebijing may reduce the time of mechanical ventilation, increase OI, keep a fit RI and decrease the secrum level of TNF-a, which can protect the lung after CPB. According to decrease the release of TNF-a, the inflamation will be calm down partly. However, there is no classify of cardiac disease which would make a bia.