依达拉奉在体外循环术中的心肌保护作用

Myocardial protection of edaravone in patients underwent cardiopulmonary bypass surgery

目的探讨依达拉奉在体外循环术中的心肌保护作用。方法将60例需行体外循环心脏停跳二尖瓣置换术的风湿性心脏病患者随机分为实验组和对照组各30例。实验组于预充液中按0.5 mg/kg加入依达拉奉注射液,对照组加入等量生理盐水,分别于术前(T1)、转机30 min(T2)、停机(T3)、术毕(T4)、术后24 h(T5)、术后72 h(T6)共6个时点分别检测全血LDH(乳酸脱氢酶)、CK-MB(肌酸激酶同工酶)、cTnT(肌钙蛋白)及血清IL-6(白介素-6)、IL-8(白介素-8)含量的变化。结果 (1)心肌酶LDH、CK-MB、cTnT术前各组差异无统计学意义(P>0.05),体外循环(CPB)开始后各时点心肌酶的含量均较术前增高(P<0.01),且各时点实验组均较对照组低,两组差异有统计学意义(P<0.05)。(2)IL-6、IL-8浓度水平随CPB及手术时间逐渐增高,均于手术结束时达高峰,术后24 h下降,术后72 h恢复至术前水平,但实验组低于对照组,两组浓度水平差异有统计学意义(P<0.01)。结论 (1)依达拉奉注射液用于体外循环术中心肌酶漏出量降低,表明依达拉奉可减轻心肌缺血再灌注损伤,对心肌具有保护作用。(2)依达拉奉可通过清除体内过量生成的氧自由基及减少炎性因子的生成,减轻全身炎性反应,具有减轻体外循环中急性心肌损伤的作用。

Objective To explore the myocardial protection ofedaravone in patients underwent eardiopulmo- nary bypass （CPB） surgery. Methods Sixty patients with rheumatic heart disease preparing for mitral valve replace- merit were randomly divided into two groups： control group （n=30） and experimental group （n=30）. In experimental group, patients received edaravone （0.5 mg/kg） in circuit priming fluids and patients in control group received equal volume of normal saline. Blood samples were collected respectively at preoperation （TO, 30 minute of CPB （T2）, the ends of CPB （T3）, postoperation （T4）, 24 hours after operation （T5） and 72 hours after operation （T6） for the assessment of LDH, CK-MB, cTnT, IL-6 and IL-8. Results （1） There was no difference between each group in the levels of LDH,CK-MB and cTnT before the operation. After the CPB had begun, levels of all myocardial enzymes were signifi- cantly higher than that before the operation （P〈0.01） at each time points. Meanwhile, levels of all myocardial enzymes were significantly lower in the experimental group than those in the control group （P〈0.05）. （2） The levels of IL-6 and IL-8 in both groups elevated from the beginning of CPB and reached peak at the end of the surgery. Both IL-6 and IL-8 declined from the time of 24 hours after the surgery and recovered to normal at the time of 72 hours after the sur- gery. However, the levels of IL-6 and IL-8 in experimental group were significantly lower than those in control group （P〈0.01）. Conclusion （1） Edaravone offers protection to myocardial ischemia-reperfusion injury during CPB sur- gery by reducing the leakage of myocardial enzymes. （2） Edaravone can decrease the plasma levels of inflammatory cytokines such as IL-6 and IL-8 and eliminate excessive oxygen free radical in vivo to alleviate the postoperative sys- temic inflammatory response in cardiac surgery. It can also relieve the acute myocardial dama^ze in CPB.