临床用药研究依达拉奉在心脏不停跳手术中对心肌的保护作用

摘要

Objective To evaluate the myocardial protective effects of edaravone in patients udnerwent cardiopulmonary bypass ( CPB ) surgery, onbeating - heart Methods Sixty patients with rheumatic heart disease preparing for mitral valve replacement were randomly divided into two groups: experimental group ( Group E, n = 30 ), in which patients received edaravone injection 0.5 mg/kg in circuit priming fluids; and control group ( Group C, n = 30 ), in which patients received equal volume of normal saline. Blood samples were collected before surgery ( T1 ), at 30 minute of CPB ( T2 ), at the ends of CPB ( T3 ) and operation ( T4 ), 24 hours afler operation ( Ts ), and 72 hours afler operation ( T6 ) for assessment of SOD, CK - MB, LDH, cTnT and MDA. Results There was no significant difference of LDH, CK - MB and cTnT revealed at T1 between the 2 groups ( P ＞0.05 ). However, significant elevations of LDH CK - MB and cTnT were observed at T2 to T6 , when comparing with those at T1 ( P ＜ 0. 05 ). Meanwhile, significantly lower level of these enzymes were detected in Group E at T2 to T6( P ＜ 0. 05 ). There was no significant difference of MDA and SOD revealed at T1 between the 2 groups ( P ＞ 0.05 ). SOD decreased continuously from T2 , reached the nadir at T4 , and rebounded aflerward.Significantly lower level of SOD was observed in Group C, comparing with that in Group E, at T2 to T6( P ＜0.01 ). MDA increased continuously from T2 , reached the park at T4 , and reduced aflerward. Significantly higher level of MOD was observed in Group C, comparing with that in Group E, at T2 to T6( P ＜ 0.01 ). Conclusion Edaravone offers protective effect on nyocardial ischemia -reperfusion injury during open heart surgery, via increasing the activty of SOD and reducing the production of MDA.%目的 探讨依达拉奉在心脏不停跳手术中对心肌的保护作用.方法 将60例需行二尖瓣置换术(MVR)的风湿性心脏病患者随机分成依达拉奉组(E组)30例,对照组(C组)30例.E组于预充液中按0.5 mg/kg加入依达拉奉,C组加入等量生理盐水.分别于术前(T1)、转机30 min(T2)、停机(T3)、术毕(T4)、术后24 h(T5)、术后72 h(T6)各时点检测全血乳酸脱氢酶(LDH)、肌酸激酶同工酶(CK-MB)、肌钙蛋白(cTnT)、超氧化物歧化酶(SOD)及丙二醛(MDA)含量变化.结果 (1)心肌酶LDH、CK-MB、cTnT术前两组差异无统计学意义(P＞0.05),体外循环(CPB)开始后各时点心肌酶的含量均较术前增高(P＜0.01),且各时点E组均较C组低,两组差异有统计学意义(P＜0.05).(2)MDA、SOD术前两组差异无统计学意义(P＞0.05),SOD从T2时点开始持续下降,至T4最低值后逐渐升高,CPB开始后C组各时点均低于E组(P＜0.01),且C组在各时点下降更为显著(P＜0.01);两组MDA在CPB开始后均较术前升高,T4时点开始下降,逐渐接近正常水平,两组之间浓度水平差异有统计学意义(P＜0.01),C组各时点升高更为显著(P＜0.01).结论 依达拉奉注射液用于心脏不停跳心内直视手术,可以降低心肌酶漏出量,减少MDA的产生,提高心肌细胞SOD活性,表明依达拉奉有利于减轻心肌缺血再灌注损伤,对心肌具有保护作用.