依达拉奉对心脏瓣膜置换术患者颅内静脉血浆S-100β蛋白和NSE浓度的影响

目的探讨依达拉奉对心脏瓣膜置换术患者围体外循环期颅内静脉血浆S-100β蛋白（S-100β）和神经元特异性烯醇化酶（NSE）水平的影响及其机制。方法 20例心脏瓣膜置换术病人,随机分为依达拉奉组（E组）和对照组（C组）,每组10例。于麻醉后用药前（T0）、升主动脉开放时（T1）、CPB结束时（T2）、CPB结束后30 min（T3）、CPB结束后4 h（T4）抽取颈静脉球部血,检测血浆丙二醛（MDA）、超氧化物歧化酶（SOD）、总抗氧化能力（T-AOC）水平;于T0、T2、T3、T4检测S-100β、NSE、白细胞介素-6（IL-6）、肿瘤坏死因子（TNF-a）水平。结果与T0时比较,S-100β、NSE、IL-6浓度两组在T2-4时升高（P〈0.05或0.01）;TNF-a浓度C组T2-4时升高（P〈0.01）,E组仅在T2时升高（P〈0.05）;MDA浓度C组T1-4时升高（P〈0.05或0.01）,E组仅在T2-3时升高（P〈0.05）;SOD活力C组T1-4时降低（P〈0.05或0.01）,E组各时点无显著变化;T-AOC两组在T1-4时降低（P〈0.05或0.01）。与C组比较,E组S-100β、NSE、TNF-a、IL-6浓度在T2-4时降低（P〈0.05或0.01）,MDA浓度在T1-4时降低（P〈0.05）,SOD活力和T-AOC在T1-4时升高（P〈0.05或0.01）。结论依达拉奉在心脏瓣膜置换术患者围体外循环期可减少脑静脉血浆S-100β和NSE的产生,从而减轻脑损伤。

Effect of edravaone on cerebral venous blood S-100 protein and neuron-specific enolase in patiens undergoing cardiac valve replacement during cardiopulmonary bypass

Objective To investigate the effect of edravaone on cerebral injury in patients undergoing cardiac valve replacement during cardiopulmonary bypass.Methods Twenty NYHA Ⅱto III patients of both sexes（11male,9 female） aged 20-60 years undergoing cardiac valve replacement with hypothermic cardiopulmonary bypass（CPB） were divided into two groups randomly which were control group（group C,n=10） and edaravone group（group E,n=10）.In group E 0.5mg/kg edravaone intravenously before CPB and same amount of edaravone added into the primary solution and group C received normal saline instead of edaravone.Internal jugular vein was cannulated.Blood samples were taken from jugular after induction of anesthesia.Blood samples were taken before skin incision（T0）.the time of arotic unclamping（T1）,the termination of CPB（T2） and 30 min（T3）,the termination of CPB 4h（T4）.After discontinuation of CPB for determination of MDA concentrations,SOD activity and T-AOC concentrations,The plasma of S100β protein,tumor necrosis factor-alpha（TNF-α）,neuron specific evolase（NSE） and Interleukin-6（IL-6） were measured at T0,T2,T3 and T4.Results Plasma levels of S100β increased during and after T2 in group C,and only increase at T3 in group E,there was no significant difference between the two groups.NSE was increased at T2 and T3,and significantly increased at T3 compared to the baseline values（T0） in both groups,and was significantly lower in group E than in group C（P0.05）.Plasma levels of TNF-α was significantly increased during and after T2 compared to the baseline values（T0） in group C,but only increase at T2 in group E,and was significantly lower in group E than in group C（P0.05）.IL-6 was significantly increased during and after T2 compared to the baseline values（T0） in group C,but was only increased at T2 and T3 in group E,and was significantly lower in group E than in group C（P0.05）.MDA was significantly increased during T1 from T3 compared to the baseline values（T0） in both groups,and was significantly lower in group E than in group C（P0.05）.SOD activity was significantly decreased during and after T1 as compared to the baseline valve（T0） in group C,while there was no significant change in SOD activity in group E,and was significantly lower in group C than in group E（P0.05）.T-AOC activity were significantly decreased during and after T1 as compared to the baseline valve（T0） in both groups,and was significantly lower in group C than in group E（P0.05）.Conclusion Edaravone can attenuate cerebral injury during cardiac valve replacement with CPB.The possible mechanisms are that edaravone can protect the activity of SOD,increase the activity of T-AOC and SOD,decrease the production of IL-6.MDA and TNF-a,and reduce the production of S100β and NSE,in order to reduce cerebral injury.