依达拉奉对不停跳冠状动脉旁路移植术患者心功能的保护作用

目的:研究依达拉奉在不停跳冠状动脉旁路移植术(OPCABG)中对患者心功能保护的有效性。方法:100例美国麻醉医师学会(ASA)Ⅲ～Ⅳ级、纽约心脏病协会心脏指数(NYHA)心功能Ⅱ～Ⅲ级37～65岁择期行OPCABG患者,随机分为试验组(Y组,n=50)及对照组(C组,n=50),采用双盲对照研究。麻醉以静脉输注丙泊酚、舒芬太尼为主,派库溴铵0.1mg·kg-1·h-1并间断吸入七氟烷维持,麻醉期间控制脑电双频指数(BIS)值为40～50。术中使用正性肌力药为多巴胺3～8μg·kg-1·min-1或肾上腺素0.03～0.10μg·kg-1·min-1,血管扩张药为硝酸甘油0.1～0.5μg·kg-1·min-1。收缩压维持在95～135mmHg(1mmHg=0.133kPa),中心静脉压(CVP)6～12mmHg。Y组患者桡动脉穿刺完成后开始静脉泵入依达拉奉60mg(40mL),C组以同样外观注射器泵入40mL生理盐水。2组均先以40mL/h速度持续泵入30min,然后以5mL/h速度泵入剩余药物,直至手术结束或药物用完。比较麻醉前后及用依达拉奉前后2组患者生命体征,记录2组肝、肾功能和心功能变化,记录手术前、切皮后1h、缝皮前及手术后24h,4个时间点的血清超氧化物歧化酶(SOD),丙二醛(MDA)含量,手术前1d及手术后24h血浆脑钠肽(BNP),肌钙蛋白I(cTnI)含量,随访记录患者各种并发症并加以比较。结果:手术前后及使用依达拉奉前后,2组患者生命体征及肝肾功能差异无统计学意义(P0.05)。2组患者用药前SOD、MDA、BNP及cTnI组间差异无统计学意义(P0.05),切皮后1h,缝皮前及术后24h,SOD活性Y组均明显高于C组(P0.01),MDA值Y组均明显低于C组(P0.01);术后24hBNP及cTnI值,Y组低于C组(P0.05);术后左心室射血分数(LVEF)%,Y组明显高于C组(P0.01);术后呼吸机治疗时间,Y组C组(P0.05);ICU停留时间及总住院时间,Y组C组(P0.01)。结论:依达拉奉用于OPCABG可有效地清除体内氧自由基,减少心肌酶的释放,对心脏功能有保护作用,可改善患者预后。

Myocardial protective effects of edaravone(MCI-186) in off-pump coronary artery bypass grafting(OPCABG)

Objective：To investigate the myocardial protective effects of edaravone for patients undergoing off-pump coronary artery bypass grafting（OPCABG）.Methods：100 ASA Ⅲ-Ⅳ,NYHA Ⅱ-Ⅲ patients（88 males,12 females）,aged 37-65 undergoing elective OPCABG were randomly divided into two groups：edaravone group（group Y,n = 50） received edaravone 0.5 mg/kg in normal solution,and control group（group C,n = 50） did not receive edaravone.The two groups were inducted and maintained by the same anesthetic medications.During the operation,the drugs of anesthesia were dosed in the same way.Blood samples were taken before skin incision（T1）,1 h after skin incision（T2）,at the end of the operation（T3）,and 24 h after the operation（T4） for determination of SOD,MDA,BNP and cTnI.Meanwhile,the clinical data of the two groups was observed-including ABP,HR,ECG,SPO2,PH,PaO2,PaCO2,ALT,AST,BUN,Cr,LVEF,and subsequent events like malignant syndromes,ventilation period,and the length of hospitalization.Results：After edaravone infusion during the operation,SOD was higher in group Y than group C at T2,T3 and T4 significantly（P 0.01）.MDA was lower in group Y than group C significantly（P 0.01）.BNP and cTnI were lower in group Y than group C 24h after the operation（P 0.05）.LVEF was lower too in group Y significantly（P 0.01）.Evenmore,the ventilation period was shorter in group Y（P 0.05）,at the same time,ICU stay duration and the length of hospitalization were shorter in group Y significantly（P 0.01）.Conclusion：Edaravone can eliminate OFR effectively in off-pump coronary artery bypass grafting,and reduce cTnI,so that protect the myocardial function.As the result,the prognosis of patients can be ameliorated.