依达拉奉对止血带性心肌损伤的保护作用

Protective effect of Edaravone on myocardial injury induced by tourniquets

目的探讨依达拉奉对止血带性心肌损伤的保护作用。方法将44例ASA分级I～II级、单侧下肢手术、手术时间1～1.5h及需用止血带患者随机分为3组,上止血带前注射依达拉奉组(E1组,=14)、上止血带后注射依达拉奉组(E2组,n=15)和对照组(C组,=15)。均采用L2～3的连续硬膜外麻醉。在上止血带前(T0)、上止血带后1h(T1)、松止血带后0.5h(T2)、2 h(T3)、6 h(T4)、24 h(T5)各时点抽取静脉血测定血浆肌钙蛋白I(cTnI)、肿瘤坏死因子-(TNF-)、白介素-6(IL-6)、IL-8、血浆丙二醛(MDA)、超氧化物歧化酶(SOD)及髓过氧化物酶(MPO)的浓度。结果与T0比较,C组在T3～T5时点IL-6和IL-8浓度升高(均<0.05),在T2～T5时点TNF-浓度和MDA浓度升高,SOD降低(均<0.05),在T2～T4时点MPO升高(均<0.05),在T4～T5时点cTnI浓度升高(均<0.05)。E1组和E2组在T3～T4时点IL-6和IL-8浓度升高,但与同时点的C组相比明显减少(均<0.05);E1组和E2组在T2～T4时点TNF-浓度升高,但与同时点的C组相比明显减少(均<0.05);E1组和E2组在T2～T5时点MDA和SOD与同时点的C组比较明显减少(均<0.05);E1组和E2组在T2～T4时点MPO与同时点的C组比较明显减少(均<0.05);E1组和E2组在T4～T5时点cTnI浓度与同时点的C组比较明显减少(均<0.05)。结论依达拉奉能有效改善下肢手术患者松止血带后心肌损伤,其机制与清除氧自由基、抑制脂质过氧化反应,抑制炎性细胞因子过度释放及减少中性粒细胞的聚集有关。

Objective To investigate the protective effect of edaravone on myocardial injury induced by tourniquets in patients undergoing orthopedic operations.Methods Forty-four patients aged 25～60 years old whose tourniquets duration varied from 1 to 1.5 h and matched American Society of Anesthesiologists Physical Status Ⅰ～Ⅱ,were randomly divided into three groups.Edaravone（0.5mg/kg） was given intravenous before tourniquet inflation（group E1,n=14） or after tourniquet inflation（group E2,n=15）.Equal volume of normal saline was infused at the same time points in the control group（group C,n = 15）.Patients in all the three groups were received epidural block（L2～3） for operation.Plasma samples for measuring the concentration of cardiac troponin I（cTnI）,tumor necrosis factor-alpha（TNF-a）,interleukin-6（IL-6）,interleukin-8（IL-8）,malondialdehyde（MDA）,superoxide dismutase（SOD） and activity of myeloperoxidase（MPO） were taken just before tourniquet inflation（T0）,1 h after inflation（T1）,and 0.5 h（T2）,2 h（T3）,6 h（T4）,24 h（T5） after tourniquet deflation.Results Compared with T0 point,cTnI in T4 and T5 point were increased;the concentration of IL-6 and IL-8 at T3～5 points were also increased;the concentration of TNF-€%Z and MDA was increased but the concentration of SOD was decreased at T2～5 points;the activity of MPO were also increased at T2～5 points in group C（P0.05）.The concentration of IL-6 and IL-8 at T3～4 points was significantly higher in group E1 and E2 than that at T0 point and was significantly less than that in group C（P0.05）.The concentration of TNF-a at T2～4 points were significantly higher in group E1 and E2 than those at T0 point and was significantly less than those in group C（P0.05）.There were no significantly differences in concentration of MDA,SOD and the activity of MPO at T0～5 points in group E1 and E2（P0.05）,but was significantly less than those in group C（P0.05）.The concentration of cTnI at T4～5points in group E1 and E2 was significantly less than that in group C（P0.05）.Conclusions Edaravone using in patients with lower limb surgery can reduce myocardial injury after tourniquet release which might be attributed to scavenging oxygen free radicals,inhibiting lipid peroxidation,inhibiting the excessive release of inflammatory cytokines and reducing neutrophil accumulation.