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J Thorac Cardiovasc Surg 2005;130:258-264
© 2005 The American Association for Thoracic Surgery

Surgery for Congenital Heart Disease

Ginsenosides compound (shen-fu) attenuates gastrointestinal injury and inhibits inflammatory response after cardiopulmonary bypass in patients with congenital heart disease

^a Anesthesiology Research Laboratory, Renmin Hospital, Wuhan University, Wuhan, People’s Republic of China
^b Department of Anesthesiology, Renmin Hospital, Wuhan University, Wuhan, People’s Republic of China

Presented in part at the First Global Conference on Cardiovascular Clinical Trials and Pharmacotherapy incorporating the Second World Heart Federation Global Conference on Cardiovascular Clinical Trials and Thirteenth International Society of Cardiovascular Pharmacotherapy Congress, Oct 1–3, 2004.

Received for publication November 21, 2004; revisions received January 26, 2005; accepted for publication February 7, 2005.

^_* Address for reprints: Zhengyuan Xia, MD, Anesthesiology Research Laboratory, Department of Anesthesiology, Renmin Hospital, Wuhan University, Wuhan, 430060, People’s Republic of China, or Faculty of Pharmaceutical Sciences, The University of British Columbia, 2146 E Mall, Vancouver, BC, V6T 1Z3 Canada (Email: zhengyuan_xia{at}yahoo.com).

OBJECTIVE: This study was undertaken to demonstrate that gastrointestinal mucosal injury occurs during cardiopulmonary bypass in children, increasing systemic inflammatory responses, and to determine whether shen-fu injection (the major components of which are ginsenosides compound, extract of Panax ginseng shown to have antioxidant properties) could attenuate gastrointestinal mucosal injury and subsequent inflammatory responses.

METHODS: Twenty-four children undergoing heart surgery for congenital heart defects were randomly assigned to groups C (placebo control, n = 12) and G (1.35 mg/kg ginsenosides compound intravenously before and throughout the course of cardiopulmonary bypass, n = 12). Central venous blood samples were taken before cardiopulmonary bypass and at 60 and 120 minutes after aortic declamping (reperfusion). Gastric intramucosal pH was measured by perioperative tonometry. Plasma lipid peroxidation product malondialdehyde, myocardium-specific creatine kinase isoenzyme MB activity, diamine oxidase, lipopolysaccharide, and interleukin 6 were all measured.

RESULTS: Significant decrease in gastric intramucosal pH and increase in plasma diamine oxidase were seen during reperfusion in group C, accompanied by increases in plasma levels of malondialdehyde, lipopolysaccharide, interleukin 6, and creatine kinase isoenzyme MB (P < .01 vs before cardiopulmonary bypass). Shen-fu injection significantly attenuated these changes (P < .05). Consequently, fewer patients in group G (2/12) than in group C (7/12) needed postoperative inotropic support. Postoperative intensive care unit stay was shorter in group G than in group C. A tight positive correlation was seen between diamine oxidase and interleukin 6 at 60 minutes after aortic declamping and between diamine oxidase and lipopolysaccharide at 120 minutes after aortic declamping (r = 0.79, P < .0001).

CONCLUSION: Ginsenosides compound may attenuate gastrointestinal injury and inhibit inflammatory response after cardiopulmonary bypass in patients with congenital heart disease.

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