依达拉奉对心脏瓣膜置换术患者脑损伤的影响

目的:探讨自由基清除剂依达拉奉对心脏瓣膜置换术患者脑损伤的影响及其机制。方法:选择行二尖瓣或主动脉瓣置换术患者30例,随机分为实验组(n=14),对照组(n=16)。实验组依达拉奉0.5mg/Kg在麻醉诱导后5min静脉滴注及另外0.5mg/kg于主动脉开放前5min加入体外循环机内;对照组则不用依达拉奉。两组分别于麻醉诱导后5min(T1)、主动脉开放后5min(T2)、1h(T3)、2h(T4)、6h(T5)和24h(T6),采集患者颈内静脉血,检测血清S-100蛋白、神经元特异性烯醇化酶(NSE)、丙二醛(MDA)浓度、超氧化物歧化酶(SOD)活性和总抗氧化能力(TAOC)。结果:两组S-100蛋白、NSE、MDA和TAOC浓度在T2-5时间段高于T1(P<0.01);实验组S-100蛋白、NSE和MDA浓度在T2-5时间段低于对照组(P<0.05或0.01);实验组SOD活性和TAOC浓度在T2-5时间段高于对照组(P<0.05或0.01)。结论:依达拉奉可减轻体外循环(CPB)下心脏瓣膜置换术患者的脑损伤,其机制可能与其提高SOD活性,减少MDA产生,增强TAOC,抑制脂质过氧化,减轻脑组织缺血再灌注造成的损伤有关。

Effects of edaravone on cerebral injury in patients undergoing cardiac valve replacement

Objective: To investigate the effects of the free radical scavenger edaravone on cerebral injury and the possible mechanisms during cardiac valve replacement.Methods: Thirty patients undergoing mitral or aortic valve replacement(MVR or AVR) with CPB were randomly divided into two groups: control group and experiment group.In experiment group 0.5mg/kg edaravone was given by intravenous injection at 5 min after anesthesia induction and 0.5mg/kg edaravone was given at 5 min before aortic declamping.Blood samples were collected from intrajugular vein for determination of serum levels of S-100 protein,neuron-specific enolase(NSE),malondialdehyde(MDA),super oxide dismutase(SOD) activity and total antioxidant capacity(TAOC) at six time-points:5 min after anesthesia induction(T1),5 min after aortic declamping(T2),1h(T3),2h(T4),6h(T5),24h(T6) after aortic declamping.Results: The serum levels of S-100 protein,NSE?MDA and TAOC were significantly increased after aortic declamping(T2-5) compared to the baseline values before CPB(T1)(P < 0.01).The serum levels of NES,S-100 protein and MDA after aortic declamping(T2-5) were significantly lower in the experiment group than those in the control group(P < 0.05 or 0.01).SOD activity and TAOC after aortic declamping(T2-5) were significantly higher in the experiment group than those in the control group(P < 0.05 or 0.01).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 TAOC and decrease the production of MDA in order to reduce cerebral inchemia-reperfusion injury.