依达拉奉在二尖瓣置换合并冠状动脉搭桥术中的脑保护研究

The Study of Edaravone's Brain Protection in Mitral Valve Replacement Combined with Coronary Artery Bypass Grafting

目的 :观察依达拉奉在二尖瓣置换合并冠状动脉搭桥术中的脑保护作用,并探讨其机制。方法 :选择32例择期首次在体外循环下行二尖瓣置换合并冠状动脉搭桥术患者,按随机数字表法分为治疗组及对照组,各16例。治疗组于麻醉诱导后静滴依达拉奉0.5 mg/kg,对照组静滴等剂量0.9%氯化钠注射液。分别于切皮前(T1)、主动脉开放后5 min(T_2)、6 h(T_3)、24 h(T_4)、48 h(T_5)采血,测定血浆神经组织蛋白(S-100蛋白)及神经元特异性烯醇化酶(NSE)。记录两组术后神经系统并发症的发生情况。结果 :两组患者无死亡,均顺利出院。两组在体外循环时间、主动脉阻断时间、辅助通气时间经比较,差异无统计学意义(P>0.05)。两组NSE和S-100含量在T_1时差异均无统计学意义(P>0.05),在T_2时均达到峰值,后逐渐回落。对照组NSE在T_2~T_5时与T_1比较,均显著升高(P<0.01),且在T_2~T_3时明显高于治疗组(P<0.05);对照组S-100在T_2~T_4时均显著高于T_1(P<0.01),且在T_2~T_4时明显高于治疗组(P<0.05),两组S-100在T_5时基本降至正常。两组患者术后认知功能障碍发生率比较,差异无统计学意义(P>0.05)。结论 :依达拉奉可以有效清除脑缺血再灌注损伤产生的自由基,可减少NSE和S-100蛋白在围体外循环期的表达,呈现其脑保护的作用。

Objective:To observe the cerebral protective effect of edaravone in mitral valve replacement with bypass operation of coronary artery, and to explore its mechanism. Methods:32 patients first underwent mitral valve replacement combined with bypass operation of coronary artery under cardiopulmonary bypass were randomly divided into the edaravone treatment group and the control group, with 16 cases in each group. Patients in the treatment group were treated with intravenous drip of edaravone 0.5 mg/kg after anesthesia induction, and patients in the control group was injected with the same amount of 0.9% sudium chloride injection. The neuron specific enolase(NSE) and neuron S-100 protein levels in plasma were measured before skin incision(T_1), and at 5 min(T_2), 6 h(T_3), 24 h(T_4) and 48 h(T_5) after aortic declamping. The post-surgery neurological complications of the two groups were recorded. Results:There were no deaths in both groups and the patients were discharged smoothly. There was no significant difference between the two groups in the time of extracorporeal circulation, aortic occlusion and assisted ventilation(P>0.05). NSE and S-100 content between the two groups at T_1 were not statistically significant(P>0.05), they reached the peak at T_2, and then decreased gradually. In the control group, NSE increased markedly at T_2~T_5 when compared with that at T_1(P<0.01), and was apparently higher than that in the edaravone treatment group(P<0.05) at T_2~T_3. In the control group, S-100 significantly increased at T_2~T_4 when compared with that at T_1(P<0.01), and was apparently higher than that in the edaravone treatment group at T_2~T_4(P<0.01). S-100 content of two groups basically dropped back to normal at T_5. There was no significant difference in the incidence of postoperative cognitive dysfunction between the two groups(P>0.05). Conclusion:Edaravone can effectively scavenge the free radicals produced by reperfusion trauma post cerebral ischemia, and reduce the expression of NSE and S-100 during cardiopulmonary bypass, to achive the cerebral protective effect.