体外循环心内直视手术期间依达拉奉对心肌缺血/再灌注损伤的保护作用  

Protection of edaravone against myocardial ischemia-reperfusioninjury in patients undergoing open heart Surgery

作　　者：李辉[1] 明豫军[1] 邹定全[1] 徐军美 常业恬[1] 

机构地区：[1]中南大学湘雅二医院麻醉科,湖南长沙410011

出　　处：《中国现代医学杂志》2012年第2期47-50,54,共5页China Journal of Modern Medicine

摘　　要：目的评价依达拉奉对心脏瓣膜置换术围体外循环期心肌缺血／再灌注损伤的保护作用。方法选择30例风湿性心脏病心内直视瓣膜置换术患者，随机分为3组，每组10例，还原型谷胱甘肽组（glutathionegroup，G组）、依达拉奉组（edaravonegroup，E组）和对照组（controlgroup，C组）。麻醉诱导后G组和E组用0．9％盐水50mL分别加入谷胱甘肽30mg／kg或依达拉奉1mg／kg，切皮前泵入一半，余下一半开主动脉前5min加入体外循环机器中。C组用同样体积0．9％盐水同样方法加入。于切皮前（T0）、阻断主动脉30min（T1）、开放主动脉1h（T2）、术后4h（T3）、术后24h（T4）抽血用双抗体夹心ELISA法测血浆胞间黏连分子1（interceUularadhesionmolecule1，ICAM-1）的水平，用黄嘌呤氧化酶法测定血浆锰超氧化物歧化酶（manganesesuperoxidedismutase，MnmSOD）的活力，硫代巴比妥法测丙醛（methylenedioxyamphetamine，MDA）的含量，用自动胶乳增强免疫比浊法测心肌肌钙蛋白（cardiactroponin，cTnI）含量。结果①3组患者ICAM－1的浓度在T0时差异无统计学意义；C组、G组和E组在T1、L时明显高于T0（P〈0．01）；G组和E组在T2、L时明显低于C组（P〈0．05或0．01），G组与E组之间差异无统计学意义。②3组患者cTnI浓度在T0差异无统计学意义；C组、G组和E组在T2-T4时明显高于T0（P〈0．01）；G组和E组在T3-T5时明显低于C组（P〈0．01）；G组与E组之间差异无统计学意义。③3组患者MDA的浓度在T。时差异无统计学意义；C组在T1～T4时，G组在T2、T3时，E组在T2-T4时明显高于T0（P〈0．05或0．01）；G组、E组在T2-T4时明显低于C组（P〈0．05）；G组与E组之间差异无统计学意义。④3组患者Mn～SOD的浓度在T0时差异无统计学意义；G组在L时，E组在T3、T4时明显高于T0（P〈0．05或0．01）；G组在T3时，E组在T3、T4时明显高于C组（P〈0．05或0�[Objective] To evaluate the protective effect of edaravone against myocardial ischemia- reperfusion injury in patients undergoing cardiac valve replacement surgery. [Methods] Thirty ASA II-III aged （20-60） years, weighing （40-70） kg scheduled for elective valve replacement, were randomly divided into three groups： patients in Reduced Glutathione group （group G, n =10） received Reduced Glutathione 30 mg/kg in 50 mL sodium chloride, and patients in edaravone group （group E, n =10） received edaravone I mg/kg in edaravone in 50 mL sodium chloride. In two groups, half of the dose was given by iv before operation and another half was added in the priming fluid 5 minute before aortic releasing. However, in control group （group C, n =10） the patients only received the same volume of sodium chloride. Anesthesia was induced with midazolum 0.15 mg/kg, Fentanyl 10 ug/kg and vecuronium. Radial artery and right internal jugular vein were cathterized for ABP and CVP measurement. Blood samples were taken from artery line before operation （T0）, 30 min after aortic cross-clamping （T1）, 1 hour after aortic release （T2）, 4 hour post-operation （T3） and 24 hour post-operation （T4） to determine plasma ICAM-1, cTnI, MDA level and Mn-SOD give out the full name activity. [Results] There was no significant difference in age, weight, duration of CPB time and aortic cross- clamping time between three groups. The ICAM-1, cTnI, MDA and Mn-SOD activity was not significantly different in three groups at To. ICAM-1 level was lower at T2 and T3 in group G and group E than that in group C. CTnI level was higher at T2-T4 in group C than that in group G and in group E. The plasma level MDA increased after CPB in group C and was higher at T2-T4 than that in group G and in group E. MnSOD activity was higher at T3 in group G and in group E then that in group C. [Conclusion] Most of oxygen free radical was produced in the early stage of myocardial reperfusion. Reduced glutathione and edaravone can inhibit inflamm

关 键 词：依达拉奉 体外循环 心肌 缺血再灌注 氧自由基 

分 类 号：R614.2[医药卫生—麻醉学]