依达拉奉在二尖瓣置换术中心肌保护作用研究

Research of myocardial protective effect of edaravone in mitral valve replacement

目的:观察依达拉奉在二尖瓣置换术中的心肌保护作用。方法:收治首次在体外循环(CPB)下行二尖瓣置换术风湿性心脏病患者32例,随机分为两组,每组16例。试验组(E组)在含血Thomas心脏停搏液和预充液中各加入依达拉奉0.25mg/kg,对照组(C组)在含血Thomas心脏停搏液中加入等量生理盐水,经主动脉根部灌注,分别于切皮前(T1)、主动脉开放后5分钟(T2)、主动脉开放后4小时(T3)、主动脉开放后12小时(T4)、主动脉开放后24小时(T5)抽取桡动脉血,测量乳酸脱氢酶(LDH)、血清肌酸激酶同工酶(CK-MB)、肌钙蛋白I(cTnI)、血浆超氧化物歧化酶(SOD)水平,并用光镜、电镜观察右心房心肌组织形态结构和超微结构的变化,记录体外循环时间、主动脉阻断时间、辅助通气时间、心脏复跳、术后机械通气时间及48小时正性肌力药物的应用情况。结果:术前两组血清SOD、cTnI、CK-MB、LDH、心肌线粒体积分比较差异均无统计学意义(P>0.05);术后心脏自动复跳率、术后48小时多巴胺用量差异有统计学意义(P<0.01);术后各时间点血清SOD、cTnI、CK-MB、LDH、心肌线粒体积分实验组均优于对照组(P<0.05;P<0.01)。结论:依达拉奉加入心脏停搏液和预充液中具有良好的心肌保护作用。

Objective:To observe the protective effect of edaravone on myocardium in mitral valve replacement.Methods:32patients with rheumatic heart disease who were treated with mitral valve replacement under extracorporeal circulation(CPB) firstly were selected,they were randomly divided into two groups with 16 cases in each.The experimental group(E group) were treated with edaravone 0.25mg/kg joined in Thomas cardioplegic solution containing blood and priming solution.The control group(C group) were treated with the same dose of physiological saline joined in Thomas cardioplegic solution containing blood.After the perfusion at aortic root,radial artery blood was drawn respectively before skin incision(T1),5 minutes after opening aorta(T2),4hours after opening aorta(T3),12 hours after opening aorta(T4),24 hours after opening aorta(T5) to measure the levels of lactate dehydrogenase(LDH),serum creatine kinase isoenzyme(CK-MB),cardiac troponin I(cTnI),plasma superoxide dismutase(SOD).We observed the changes of right atrial myocardial tissue morphology and ultrastructure by light microscopy and electron microscopy and recorded extracorporeal circulation time,aortic blocking time,assisted ventilation time,the time of heart beat again,postoperative mechanical ventilation time and situation of application of positive inotropic drugs at 48 hours.Results:Before surgery,the differences of serum SOD,cTnI,CK-MB,LDH,myocardial mitochondria integral of the two groups were no statistical significance(P>0.05);after operation,the differences of automatic rebeating rate and consumption of dopamine at 48 hours after operation were statistically significant(P<0.01);after operation,serum SOD,cTnI,CK-MB, LDH,myocardial mitochondria integral of the experimental group were all better than that of the control group(P<0.05;P<0.01).Conclusion:Edaravone joined in Thomas cardioplegic solution containing blood and priming solution has good effects on myocardial protection.