依达拉奉对单一瓣膜置换患者心肌的保护作用

Effect of Edaravone on myocardial protection in patients with single valve replacement

目的:探讨依达拉奉(edaravone,MCI-186)对行单一瓣膜置换手术患者心肌的保护作用。方法:32例风湿性心脏病患者随机分为两组,MCI-186组17例,对照组15例。依达拉奉组接受MCI-186 0.5 mg/kg在主动脉开放前10 min一次性加入体外循环机静脉储血罐中,对照组不接受MCI-186。分别于术前、主动脉开放后8,16,72 h测量血清肌酸激酶同功酶(creatine kinase Mbmass,CK-MB)、肌红蛋白(myoglobin,Myo)、心肌肌钙蛋白I(cardiac troponin I,cTnI),于术前、主动脉开放后4,8,16,24 h测量血浆丙二醛(malonaldehyde,MDA)水平。记录复跳和术后48 h正性肌力药物应用情况。结果:①CK-MB,cTnI在主动脉开放后8 h,Myo在主动脉开放后16 h最高;组间比较CK-MB,Myo,cTnI在主动脉开放后8 h,16 h依达拉奉组均低于对照组(P<0.01)。②MDA在主动脉开放后各时点均升高,依达拉奉组在开放后各时点均低于对照组(P<0.01)。③主动脉开放后心脏自动复跳率依达拉奉组高于对照组。术后48 h多巴胺平均最大剂量依达拉奉组少于对照组(P<0.05)。结论:在再灌注前,及时给予依达拉奉可减少MDA的产生,减轻心肌缺血再灌注损伤。

Objective： To investigate the myocardial protection effect of edaravone （MCI-186） in patients with single valve replacement. Methods： Thirty-two patients with rheumatic heart disease were randomly divided into two groups： MCI-186 group（ group M, n = 17） received edaravone injection 0.5 mg/kg in venous blood reservoir of cardiopulmonary bypass unit at 10 min before declamping aorta, control group （ group C, n = 15 ） did not receive edaravone. Blood samples were taken before skin incision （ T1 ）, and at 4 h（ T2 ）, 8 h （ T3 ）, 16 h （ T4 ）, 24 h （ T5 ） after declamping aorta for determination of MDA; at T1, T3, T4 and 72 h （T6） after declamping aorta for determination of CK-MB, Myo, cTnI. Meanwhile, the clinical effectiveness of the two groups was observed. Results： ①After declamping aorta, the levels of CK-MB, Myo, cTnI at T3, T4 in group M were lower than those in group C（ P 〈0.01 ）. ②The levels of MDA in group M were higher than in group C at all time points after declamping aorta（P 〈0.01 ）. ③After declamping aorta, the spontaneous return rate was 60% in group C and 90% in group M. The amount of positive inotropic drugs in group M was less than group C（P 〈0.05）. Conclusion： Before reperfusion, MCI-186 can decrease the production of MDA in order to reduce myocardium ischemic reperfusion injury if supplied in time.