心脏术后发生MODS伴ARF时机体氧化应激状态的初步研究

目的初步观察经体外循环心脏术后多脏器功能障碍综合征(MODS)伴急性肾功能衰竭(ARF)患者的氧化应激水平,为临床治疗提供理论基础。方法测定16例经体外循环心脏术后MODS伴ARF患者及16例健康人的血清丙二醛(MDA)、超氧化物歧化酶(SOD)、谷胱甘肽过氧化物酶(GSH-Px)、总抗氧化能力(TAC),同时对患者进行MODS评分,并将评分与氧化应激参数进行相关性分析。结果116例患者,8例存活,8例死亡(病死率50%);2与健康对照组相比,MODS伴ARF组在性别、年龄方面无显著性差异,TAC,SOD代偿性升高,但GSH-Px明显下降,MDA显著升高。3MDA同MODS评分呈正相关;GSH-Px同MODS评分呈负相关。SOD、TAC同评分无明显相关性。结论1经体外循环心脏手术后MODS伴ARF的患者发生了氧化应激。2监测MDA和GSH-Px有助于判断病情。3在MODS伴ARF的治疗中,有必要采用各种治疗措施恢复机体的氧化抗氧化。

Elementary study of oxidative stress in patients with MODS and ARF after cardiac surgery

Objective: To evaluate oxidative stress levels in patients with multiple organ dysfunction syndrome(MODS) and acute renal failure(ARF) after cardiac surgery by cardiopulmonary bypass.Methods: Sixteen patients with MODS and ARF after cardiac surgery and sixteen healthy people were included in the study.The serum levels of malondialdehyde(MDA) ,superoxide dismutase(SOD), glutathione peroxidase(GSH-Px) and total anti-oxidant capacity(TAC) and MODS scores were examined and registered. The correlation between MODS scores and biomarkers of oxidative stress was analyzed.Results: ① The mortality of 16 patients was 50%. ②Compared with healthy control group,age and gender in ARF and MODS group were not significantly different; TAC and SOD was reactively increased, GSH-Px was significantly decreased and MDA was significantly increased . ③ The correlation between MODS scores and MDA was positive,while it was negative between MODS scores and GSH-Px. The correlation between MODS scores and SOD and TAC was not significant. Conclusion :① Oxidative stress arised in patients with MODS and ARF after cardiac surgery.② The serum levels of MDA and GSH-Px were helpful to judge the severe state of MODS and ARF after cardiac surgery .③ During the treatment of the patients,it was necessary to adopt all kinds of methods to correct the imbalance of oxidative and anti-oxidant systems.