依达拉奉对主动脉弓部手术深低温停循环脑缺血再灌注损伤的保护作用

目的:研究依达拉奉对主动脉弓部手术行深低温停循环下手术时脑缺血再灌注损伤的保护作用。方法:选择我院2001年3月至2010年9月期间,对主动脉Bentall术、全主动脉弓替换和象鼻支架置入术患者60例,年龄37～65岁,平均(56.3±7.6)岁,美国麻醉医师协会(ASA)分级Ⅲ～Ⅳ级,心功能分级(NYHA)Ⅱ～Ⅲ级。随机分为试验组(Y组,30例)与对照组(C组,30例),全组采用相同的麻醉方法。分别于术前(T1)、深低温停循环恢复循环后5 min(T2)、1 h(T3)、2 h(T4)、6 h(T5)和24 h(T6)测定神经元特异性烯醇化酶(NSE),丙二醛(MDA)的含量及血清超氧化物歧化酶(SOD)活性和总抗氧化能力(TAOC),比较2组各个时间点各检测值的变化趋势和差异。结果:全组MDA均较术前明显升高,对照组显著升高(P<0.05)。SOD在深低温停循环开放后持续下降,但对照组在各时间点下降的更为显著(P<0.05)。2组TAOC较术前显著升高,试验组高于对照组(P<0.05)。2组NSE较术前显著升高,试验组显著低于对照组(P<0.05)。结论:依达拉奉用于大血管深低温停循环手术,能够有效地降低体内氧自由基水平,提高机体抗氧化活性,减少MDA的产生,使TAOC增强,从而减轻缺血再灌注损伤所致脑损伤程度,对术中及术后的脑保护具有积极作用。

The protective effects of edaravone to cerebral ischemia reperfusion injury during aortic arch replacement surgery

Objective:To investigate the protective effects of edaravone to cerebral ischemia reperfusion injury for patients undergoing deep hypothermic circulatory arrest(DHCA) during great artery surgery.Methods:A total of 60 patients undergoing total aortic arch replacement combined with elephant trunk implantation from to were recruited.They were randomly divided into two groups: edaravone group(Group Y,n=30) received edaravone 0.5 mg/kg in normal solution,and control group(Group C,n=30) received placebo.Two groups were inducted and maintained by the same anesthetic medications.During the operation,the anesthesia medications were dosed in the same way.Blood samples were collected from intrajugular vein for determination of serum levels of super oxide dismutase(SOD),malondialdehyde(MDA),neuron-specific cenolase(NSE) and total antioxidant capacity(TAOC) at following 6 time-points,before the begining of surgery(T1),after cessation of DHCA for 5min after(T2),1h(T3),2h(T4),6h(T5) and 24h(T6).Results: There were no significant differences in serum levels of SOD、MDA、NSE and TAOC between the two groups at point of T1 The serum levels of NSE、MDA and TAOC were significantly increased at points after cessation of DHCA(T2-5) compared to the value at point of T1.SOD activity and TAOC at points of cessation of DHCA(T2-5) were significantly higher in the experimental group than those in the control group(P<0.05 or 0.01).The serum levels of NSE and MDA after cessation of DHCA(T2-5) were significantly lower in the experiment group than those in the control group(P<0.05,P< 0.01).Conclusion: Edaravone can attenuate cerebral injury during aortic surgery with DHCA.Edaravone used in aortic surgery with DHCA can eliminate OFR effectively,protect the activity of SOD,increase the activity of TAOC and decrease production of MDA,which can reduce the cerebral ischemia-reperfusion injury and attenuate cerebral injury.Therefore,edaravone play a cerebral protective role during even after the operation.As the result,the prognosis of patients can be ameliorated.