依达拉奉对瓣膜置换术后患者血流动力学及肝肾功能的影响

Effect of edaravone on hemodynamics and hepatic and renal function in patients with valve replacement

目的:探讨依达拉奉(edaravone,MCI-186)对瓣膜置换术后患者血流动力学以及肝、肾功能的影响。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,试药组20例,对照组20例。试药组接受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2、8和24 h用Swan-Gans漂浮导管监测血流动力学指标,于术前、主动脉开放后8、16和72 h测量血清总胆红素(TBIL)、谷草转氨酶(AST)、谷丙转氨酶(ALT)、血尿素氮(BUN)和肌酐(Cr),记录术后正性肌力药物的应用情况。结果:①平均动脉压(MAP)、心率(HR)和肺动脉楔压(PAWP)组间比较均无统计学差异;心排指数(CI)在各组中随时间升高,在主动脉开放后8 h试药组高于对照组(P<0.05),且在2 h、24 h更显著(P<0.01);心脏每搏指数(SVI)、左心室做功指数(LVSWI)在主动脉开放后24 h试药组高于对照组(P<0.05)。②TBIL、AST、ALT、BUN、Cr组间比较均无统计学差异,且各组中BUN、Cr均在正常范围,TBIL、AST、ALT在主动脉开放后72 h亦恢复正常。试药组术后48 h多巴胺平均最大剂量少于C组(P<0.05)。结论:MCI-186能促进瓣膜置换术后患者血流动力学的恢复,改善左室功能,增加心排指数和左室做功指数,对患者肝、肾功能未见明显影响。

AIM： To study the effect of edaravone （MCI-186） on hemodynamics and hepatic and renal function of patients following valve replacement. METHODS： Forty patients with rheumatic heart disease undergoing cardiac valve replacement were randomly divided into two groups. Experimental group （n =20） received edaravone injection （0.5 mg/kg） in venous blood reservoir of cardiopulmonary bypass unit at 10 rain before declamping aorta. Control group （n = 20） received no edaravone. Hemodynamic parameters were recorded before operation and at 2, 8 and 24 h after declamping aorta and blood samples were taken before operation and at 8, 16 and 72 h after declamping aorta for determination of TBIL,AST, ALT, BUN and Cr. RESULTS： 1 ） No statistical differences were found in the levels of MAP, HR and PAWP between groups. In both groups, the levels of CI increased at 2, 8 and 24 h, but the levels in experimental group were higher than those in control group at 2 h （P 〈0. 01, 8 h （P 〈0.05） and 24 h （P 〈0.01）. The levels of SVI and LVSWI at 24 h in experimental group were higher than those in control group （P 〈 0. 05）. 2） No statistical differences were found in the levels of TBIL, AST, ALT,control group （P 〈 0. 05）. 2） No statistical differences were found in the levels of TBIL, AST, ALT, BUN and Cr between groups, and the levels of BUN and Cr were within the normal range before operation and at 8 h, 16 h and 72 h after in both groups. The levels of TBIL, AST and ALT recovered to normal at 72 h in the two groups. The amount of positive inotropic drugs in experimental group was less than in control group （P 〈0.05）. CONCLUSION： MCI-186, with no significant side effects on hepatic and renal functions, improves the hemodynamic condition and left ventricular functions.