依达拉奉在心脏不停跳手术中对心肌保护的临床研究

目的 研究依达拉奉在心脏不停跳手术基础上对心肌的保护作用.方法 将60例需行二尖瓣置换术的风湿性心脏病患者随机分成两组:依达拉奉组（E组）30例，对照组（C组）30例。E组于预充液中按0.5mg/kg加入依达拉奉，C组加入等量生理盐水。分别于术前（T1）、转机30min（T2）、停机（T3）、术毕（T4）、术后24小时（T5）、术后72小时（T6）各时点检测全血LDH、CK-MB及cTnT、SOD及MDA含量变化。结果1．心肌酶LDH、CK-MB、cTnT术前两组无差异（P＞0.05），CPB开始后各时点心肌酶的含量均较术前增高(P＜0.01)，且各时点E组均较C组低，两组间有显著差异（P＜0.05）。2．MDA、SOD术前两组无差异（P＞0.05），SOD从T2时点开始持续下降，至T4最低值后逐渐升高，CPB开始后C组各时点均低于E组（P＜0.01），且C组在各时点下降更为显著（P＜0.01）；两组MDA在CPB开始后均较术前升高，T4时点开始下降，逐渐接近正常水平，两组之间浓度水平差异有统计学显著意义（P<0.01），C组各时点升高更为显著（P＜0.01）。结论 本研究显示依达拉奉注射液用于心脏不停跳心内直视手术，可以降低心肌酶漏出量，减少MDA的产生，提高心肌细胞SOD活性，表明依达拉奉有利于减轻心肌缺血再灌注损伤，对心肌具有保护作用。

The Clinical Research of Edaravone on myocardial Protection in Patients Undergoing On Beating Heart Surgery

Objective To evaluate the effect of edaravone on myocardial protection in patients with cardiopulmonary bypass (CPB)during on beating heart surgery. Mothod Sixty patients with rheumatic heart disease undergoing mitral valve replacement were divided into two groups: experimental group(group E, n=30),patients received edaravone injection 0.5mg/kg in circuit priming fluids; control group(group C, n=30),patients received equal volume of normal saline. The blood samples were taken at six different intervals, before surgery and 30 minutes after CPB、the end of CPB、post－operation、24 hours after post－operation、72 hours after post－operation and to test the levels of SOD ,CK-MB ,LDH ,cTnT and MDA. Results 1．The content of LDH,CK-MB and cTnT in the two groups was similar before operation(p＞0.05),while those indexes of the two groups after operation were higher than before operation(P＜0.05),and those indexes of group E were lower than group C at each time points after CPB(P＜0.05).2．The level of MDA,SOD in the two groups was similar before operation(P＞0.05),while the level of SOD decreased continuously from the time point of T2.The index of SOD increased from T4 and would reached gradually to the normal level in the two groups. The level of MDA increased continuously after T2, while it began to decrease from T4 and would reached to the normal level in the two groups. The changes of SOD and MDA in the two groups were more significant than those in group C(P＜0.05).Conclusion This study suggests that edaravone injection can offer well protective effect on myocardial ischemia-reperfusion injury during open heart surgery, and confer a direct benefit to the patients by increasing the activity of SOD, decreasing the production of MDA and leaking of myocardial enzyme.