目的探讨粘附分子在体外循环脑损伤中的作用机制及银杏叶提取物的干预作用。方法选择44例心脏病需体外循环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,每组22例。观察组在体外循环予充液中加入银杏叶提取物2mg/kg(体重),对照组应用常规予充液。分别在术前、主动脉阻断后1h、CPB结束即刻、术后6h、12h、24h和48h抽取静脉血标本,检测血清P-选择素、ICAM-1和NSE浓度水平。结果对照组P-选择素于主动脉阻断1h开始升高,一直保持高水平至术后48h实验结束;观察组P-选择素于主动脉阻断1h后有所降低,持续至术后24h,术后48h恢复正常;自主动脉阻断1h开始至术后48h实验结束,血清P-选择素水平观察组显著低于对照组。对照组血清ICAM-1自主动脉阻断1h后,血清ICAM-1开始升高,并维持高水平至术后24h;观察组ICAM-1于CPB结束后开始升高,维持高水平至术后48h实验结束;主动脉阻断1h至体外循环结束,血清ICAM-1水平观察组显著低于对照组,但自术后12h开始至结束,观察组显著高于对照组。对照组血清NSE自CPB结束后开始升高,高水平维持至术后48h至实验结束;观察组血清NSE于CPB结束后开始升高,维持至术后12h,至术后24h恢复至正常;自主动脉阻断1h开始至结束,观察组血清NSE显著低于对照组。结论体外循环可引起粘附分子P-选择素和ICAM-1的升高,应用GBE可显著抑制P-选择素过度表达;GBE可能通过抑制ICAM-1的表达或封闭ICAM-1的受体途径而发挥抗炎作用,从而使脑损伤减轻。将GBE加入体外循环予充液中,对体外循环心脏手术的大脑具有显著的保护作用。 Objective To investigate the mechanism of adhesive molecules in brain injury induced by cardiopulmonary bypass and the intervention of Ginkgo biloba extract. Methods Forty-four patients with rheumatic valvular heart disease who required cardiopulmonary bypass for cardiac disease were randomly divided into observation group and control group, with 22 cases in each group. In the observation group, Ginkgo biloba extract 2 mg/kg (body weight) was added to the extracorporeal circulation prefilled liquid, and the control group was treated with routine prefilling. Blood samples were collected before operation, 1 h after aortic occlusion, immediately after CPB, and 6 h, 12 h, 24 h, and 48 h after operation. Serum P-selectin, ICAM-1, and NSE levels were measured. Results The P-selectin in the control group began to increase after aortic occlusion for 1 h, and remained high until the end of the experiment at 48 h; the observation group P-selectin decreased after aortic occlusion for 1 h and continued until 24 h after surgery. At the 48th hour after operation, it returned to normal; the autonomic arterial occlusion started from 1h to 48h after the end of the experiment, and serum P-selectin level in the observation group was significantly lower than that in the control group. In the control group, serum ICAM-1 began to increase 1 h after serum ICAM-1 autonomic arterial occlusion, and maintained high level until 24 h after surgery; ICAM-1 in the observation group began to rise after CPB and maintained high level until 48 h after surgery. At the end of the experiment, the aorta was blocked for 1 hour until the end of the extracorporeal circulation. The serum ICAM-1 level was significantly lower in the observation group than in the control group, but it was significantly higher in the observation group than in the control group from the beginning to the end of the 12th postoperative period. In the control group, serum NSE began to increase from the end of CPB and maintained at a high level until 48 hours after the end of the experiment. In the observation group, serum NSE began to rise after the end of CPB, maintained until after 12 hours, and returned to normal after 24 hours; The arterial blockade started from 1h to the end. The serum NSE of the observation group was significantly lower than that of the control group. Conclusions Cardiopulmonary bypass can induce the elevation of adhesion molecules P-selectin and ICAM-1. The application of GBE can significantly inhibit the over-expression of P-selectin. GBE may inhibit the expression of ICAM-1 or block the receptor pathway of ICAM-1. The anti-inflammatory effect is exerted to reduce brain damage. The GBE was added to the extracorporeal circulation to fill the fluid, which has a significant protective effect on the brain of cardiopulmonary bypass heart surgery.