依达拉奉在体外循环心脏手术中对心肌的保护作用

Effects of Edaravone on Myocardial Protection in Patients Undergoing Cardiac Operation With Cardiopulmonary Bypass

目的探讨心脏手术体外循环(CPB)中心肌酶、肌钙蛋白I(cTnI)和自由基代谢水平的变化及应用依达拉奉(MCI-186)对心肌的保护作用。方法40例风湿性心脏病行瓣膜置换术的患者随机分为两组,MCI-186组(M组)20例,对照组(C组)20例。M组接受MCI-1860.5mg/kg一次性加入心脏停搏液中,C组不接受MCI-186。分别于术前、术毕、术后6h、24h测量血浆超氧化物歧化酶(SOD)活力、丙二醛(MDA),血清乳酸脱氢酶(LDH)、磷酸肌酸激酶同工酶(CK-MB)、cTnI水平,记录心脏复跳及术后正性肌力药物的应用情况。结果①CK-MB术后6h,cTnI、LDH术后24h最高;组间比较M组LDH、CK-MB、cTnI术后24h,CK-MB术毕,cTnI术后6h均低于C组(P<0.05)。②MDA术后各时相均升高,术后6h、24hM组低于C组(P<0.05);SOD在术毕、术后6hM组明显高于C组(P<0.05)。③升主动脉开放后心脏自动复跳率M组为80%,C组为55%。M组术后24h多巴胺平均最大剂量少于C组(P<0.05)。结论MCI-186可提高心肌细胞SOD活性,减少MDA产生,抑制脂质过氧化反应,减轻心肌缺血再灌注损伤。

OBJECTIVE To investigate the alteration of myocardial enzymes, cardiac troponin Ⅰ （cTnI） and oxygen free radicals undergoing cardiac operation with cardiopulmonary bypass （CPB） and tile effects of edaravone（ MCI - 186） on myocardial protection. METHODS Forty patients with rheumatic heart disease undergoing cardiac valve replacement were divided into two groups： MCI - 186 group（ group M, n = 20） received edaravone injection 0.5 mg/kg in cardioplegia solution , Control group（ group C, n = 20 ） did not receive edaravone. Blood samples were taken before skin incision （T1）. at the end of operation （T2）, and at 6 h （T3）, at 24 h （T4） after aollic declamping for determination of CK- MB, LDH, cTnI, SOD and MDA. RESULTS ①After CPB the levels of LDH, CK - MB, cTnI at T4 , CK - MB at T2 ,and cTnI at T3 in group M were lower than those in group C（ P 〈0.05 ）. ②The levels of MDA increased in two groups and were markedly in group C during CPB. SOD levels at T2, T3 in group M were higher than those in group C. ③After aortic declamping, the spontaneous return rate is 80% in group M and 55% in group C. The amount of positive inotropic drugs in group M was less than group C （ P 〈 0.05 ）. CONCLUSION MCI - 186 can protect the activity of SOD and decrease the production of MDA in order to reduce myocardium ischemic and reperfusion injury.