依达拉奉对心肺转流心脏瓣膜手术患者的脑保护作用

Cerebral protective effects of edaravone in patients undergoing valve replacement under cardiopulmonary bypass

目的探讨依达拉奉在围心肺转流(CPB)期对脑保护作用。方法30例心脏瓣膜置换手术患者随机分为试验(E)组和对照(C)组,每组15例。E组采用依达拉奉0·5mg/kg,加入生理盐水100ml中,于CPB前30min内静脉输注;C组输入等量生理盐水。分别于手术开始时(T1)、CPB结束时(T2)、结束后6(T3)、24(T4)、48(T5)和72h(T6)测量血清神经元特异性烯醇化酶(NSE)(T1～T6)、S-100BB(T1～T5)水平。记录术后神经系统并发症的发生情况。结果C组NSE在T2、T3和T4均显著升高(P<0·01)且明显高于E组(P<0·05),48h后降至正常范围。E组在T2和T3显著升高(P<0·01),24h后降到正常范围。两组血清S-100BB蛋白峰值均出现在CPB结束时(T2),且明显升高(P<0·01)。C组CPB结束时血清S-100BB蛋白明显高于E组(P<0·05),C组CPB结束后6、24h较E组高,但无显著性差异。E组术后谵妄1例,认知功能障碍7例;C组术后谵妄3例,认知功能异常9例。结论依达拉奉可减少脑损伤蛋白S-100BB、NSE在围CPB期的表达,对心脏瓣膜手术患者有一定脑保护作用。

Objective To investigate the cerebral protective effects of edaravone in patients undergoing valve replacement under cardiopulmonary bypass（CPB）. Methods Thirty patients undergoing mitral, tricuspid or aortic valve surgery under CPB were randomly divided into edaravone group （E） and control group（C） with 15 cases each. The patients in group E, 0.5 mg/kg edaravone was given by intravenous injection 30 min before CPB. Blood samples were collected from intrajugular vein for determination of serum levels of S-100BB and NSE before operation （T1）, at the end of CPB （T2）, 6 h（T3 ）, 24 h（T4）, 48 h（T5） and 72 h（T6） after CPB. Results The serum levels of S-100BB at T2 and NSE at T2 -T5 were significantly increased compared to those at T1 （P〈0.05 or P〈0.01） in group （2. The serum levels of S-100BB at T2 and NSE at T3-T4 were significantly lower in group E than those in group C（P〈0. 05）. One patient suffered from delirium and 7 patients from postoperative cognitive dysfunction （POCD） in group E,which were 3 and 9 patients,respectively, in group （2. Conclusion It is suggested that edaravone has a cerebral protective effect by attenuating S-100BB and NSE concentrations in the patients undergoing heart valve replacement under CPB.