摘要
目的探讨在体外循环术(cardiopulmonary bypass,CPB)中运用自由基清除剂依达拉奉对心脏瓣膜置换术患者是否具有心脑保护作用。方法选择我院2009年3-12月行二尖瓣或主动脉瓣置换术患者30例,男性7例,女性23例,年龄23～63(41.4±10.4)岁。采用随机数字表法将患者分为研究组(14例)和对照组(16例)。研究组在体外循环开始时依达拉奉0.5mg/kg稀释成20ml一次性加入体外循环机;对照组在同一时点加入生理盐水20ml。2组分别于体外循环开始时(T0)、体外循环结束时(T1)、体外循环结束后30min(T2)、6h(T3)和24h(T4),采集患者桡动脉血,检测红细胞压积(hematocrit,HCT)、丙二醛(malondialdehyde,MDA)、诱导型一氧化氮合酶(inducible nitric oxide synthase,iNOS)、血清肌钙蛋白Ⅰ(cardiac troponin I,cTnI)、肌酸磷酸激酶同工酶(creatine kinase-MB,CK-MB)、肌红蛋白(myoglobin,Myo)、神经元烯醇化酶(Neuron-specific enolase,NSE)、S100蛋白水平。观察并记录患者术中心脏复跳情况和术后严重并发症。结果研究组HCT浓度T1～T3时间段、cTnI在T4时间点低于对照组(P<0.05);2组MDA、iNOS、CK-MB、Myo、NSE、S100蛋白在各时间点均无明显差异(P>0.05),术中心脏复跳情况亦无明显差异性(P>0.05)。研究组有1例在术后出现了急性肾功能衰竭。结论在CPB中运用依达拉奉对心脏瓣膜置换术患者无明确心脑保护作用,并有可能出现急性肾功能衰竭、红细胞减少等不良反应。
Objective To investigate the effects of the free radical scavenger,edaravone,on patients undergoing cardiac valve replacement under cardiopulmonary bypass （CPB）. Methods Thirty patients,including 7 males and 23 females,at a mean age of 41.4±10.4 （23 to 63）,undergoing mitral or/and aortic valve replacement （MVR or AVR） under CPB from March to December 2009 in our hospital were subjected,and then divided into 2 matched groups by means of random number table,study group （n=14） and control group （n=16）.Inclusion criteria： patients received valve replacement surgery under CPB; aging from 20 to 65; heart function： class Ⅰto Ⅲ; liver,kidney and lung function properly; blood gas and electrolyte properly. Exclude criteria： preoperatively used scavenger and the like; there was a history of cerebrovascular or neuropsychiatric symptoms; had a history of myocardial infarction or other coronary artery disease. In the intervention group,0.5 mg/kg of edaravone was diluted to 20 ml and introduced into CPB unit at the beginning,while the same dose of saline water was given in control group in the same way. Blood samples were collected from radial artery at following 5 time points,the beginning of CPB （T0）,the end of CPB （T1）,30 min （T2）,6 h （T3）,and 24 h （T4） after CPB. After the blood samples of all cases were collected,the serum level of hematocrit （HCT）,malondialdehyde （MDA）,inducible nitric oxide synthase （iNOS）,cardiac troponin I （cTnI）,creatine kinase-MB （CK-MB）,myoglobin （Myo）,S100 protein and neuron-specific enolase （NSE） was detected. Cardiac resuscitation and critically postoperative complications were observed. Results The level of HCT at T1-T3,cTnI at T4 was lower in study group than that in control （P0.05）. There was no obvious difference in MDA,iNOS,CK-MB,Myo,NSE and S100 protein between 2 groups at all 5 time points （P0.05）. There was also no obvious difference in the indexes of cardiac resuscitation between 2 groups （P0.05）. One case was found to have acute kidney failure in study group. Conclusion There is no obvious cardiocerebral protective effect of edaravone in cardiac valve replacement surgery under CPB,and is even accompanied by some complications,such as acute kidney failure,erythrocytes decrease,and so on.
出处
《第三军医大学学报》
CAS
CSCD
北大核心
2010年第14期1508-1511,共4页
Journal of Third Military Medical University
基金
四川省教育厅自然科学科研项目(2003B058)~~
关键词
体外循环
自由基清除剂
再灌注损伤
心脏瓣膜假体植入
手术期间
治疗
临床研究性
cardiopulmonary bypass
free radical scavengers
reperfusion injury
heart valve prosthesis implantation
intraoperative period
therapies
investigational
