老年重症患者术中应用自由基清除剂依达拉奉的多中心疗效分析

目的 观察老年重症患者手术中应用依达拉奉对预后的影响.方法 2008年7月1日至9月30日在北京朝阳医院、北京同仁医院、北京安贞医院和卫生部北京医院4家医院的400例老年重症手术患者按随机数字表法分为试验组与对照组,各200例.麻醉开始前试验组患者静脉泵入依达拉奉(60mg/40 ml)直至手术结束,对照组以等量生理盐水代替.分别于桡动脉穿刺后、手术开始后1 h及缝皮前检测超氧化物歧化酶(SOD)与丙二醛水平,记录术中情况及术后病死率、总住院日、重症监护病房(ICU)停留时间、术后机械通气时间与术后并发症情况.其中行不停跳冠状动脉旁路移植术患者于术前和术后24 h检查肌钙蛋白Ⅰ(cTn Ⅰ)与左室射血分数(LVEF).结果 试验组手术开始后1 h与缝皮前SOD水平均高于对照组(87±14)U/ml比(78±14)U/ml,(83±13)U/ml比(77±14)U/ml,P＜0.01、＜0.05];丙二醛则均低于对照组(11±5)nmol/L比(14±7)nmol/L,(11±5)nmol/L比(14±6)nmol/L,P＜0.05、＜0.01].术中低血压需持续应用血管活性药物支持者对照组多于试验组(37例比19例,P＜0.01),试验组总住院日、ICU住院日都短于对照组(21±9)d比(23±9)d,(10±7)d比(13±9)d,均P＜0.05],行不停跳冠状动脉旁路移植术患者试验组术后cTn Ⅰ和LVEF与术前和对照组相比差异均有统计学意义(均P＜0.05).结论 老年重症患者术中应用依达拉奉可防止丙二醛升高、SOD下降,降低术中低血压发生率,减少老年重症患者总住院日与ICU住院日.特别是行不停跳冠状动脉旁路移植术患者术中应用依达拉奉,术后cTn Ⅰ与LVEF测量值试验组与术前和对照组相比都有明显改善.

Abstract：

Objective To observe the effects of intraoperative application of radical scavenger edaravone in severe elderly cases. Methods A total of 400 severe elderly patients scheduled for surgery were randomly assigned to receive edaravone 60 mg/40 ml ( Group Y) or an equal volume of normal saline (Group C). The arterial blood samples were harvested at immediately after pricking, 1 hour after the beginning of surgery and before saturation to determine the levels of superoxide dismutase (SOD) and malondialdehyde (MDA). The operative duration, fluid volume, blood loss, blood transfusion volume,urine output, intraoperative adverse events, mortality rate, total hospital stay, intensive care unit (ICU)stay, postoperative mechanical ventilation time and complications were recorded. Patients undergoing offpump coronary artery bypass graft (OPCABG) were evaluated for troponin Ⅰ (cTn Ⅰ ) and left ventricular ejection fraction (LVEF) before and after 24 hours of surgery. Results SOD was higher and MDA lower in Group Y than those in Group C at 1 hour intraoperation and before saturationSOD: (87 ± 14)U/ml vs(78 ±14)U/ml, (83±13)U/mlvs(77±14)U/ml, P＜0.01, ＜0.05; MDA : (11 ±5)nmol/Lvs(14±7)nmol/L,( 11 ± 5 ) nmol/L vs ( 14 ± 6) nmol/L, P ＜ 0. 05, ＜ 0. 01]. There were more intraoperative hypotension cases requiring a continuous application of vasoactive drugs in Group C(37 cases vs 19 cases),total hospital stay(21 ±9 )d vs (23±g)d, P＜0.05] and ICU stay(10±7)dvs (13±9)d, P＜0. 05] were also longer. Postoperative cTn Ⅰ and LVEF of Group Y significantly improved in OPCABG cases ( all P ＜ 0. 05 ). Conclusion The intraoperative application of edaravone in severe elderly patients may prevent MDA increase and SOD decrease and reduce free radical damage. Especially in OPCABG patients,cTn Ⅰ and LVEF improve significantly.

Effects of intraoperative application of radical scavenger edaravone in severe elderly cases

Objective To observe the effects of intraoperative application of radical scavenger edaravone in severe elderly cases. Methods A total of 400 severe elderly patients scheduled for surgery were randomly assigned to receive edaravone 60 mg/40 ml ( Group Y) or an equal volume of normal saline (Group C). The arterial blood samples were harvested at immediately after pricking, 1 hour after the beginning of surgery and before saturation to determine the levels of superoxide dismutase (SOD) and malondialdehyde (MDA). The operative duration, fluid volume, blood loss, blood transfusion volume,urine output, intraoperative adverse events, mortality rate, total hospital stay, intensive care unit (ICU)stay, postoperative mechanical ventilation time and complications were recorded. Patients undergoing offpump coronary artery bypass graft (OPCABG) were evaluated for troponin Ⅰ (cTn Ⅰ ) and left ventricular ejection fraction (LVEF) before and after 24 hours of surgery. Results SOD was higher and MDA lower in Group Y than those in Group C at 1 hour intraoperation and before saturationSOD: (87 ± 14)U/ml vs(78 ±14)U/ml, (83±13)U/mlvs(77±14)U/ml, P＜0.01, ＜0.05; MDA : (11 ±5)nmol/Lvs(14±7)nmol/L,( 11 ± 5 ) nmol/L vs ( 14 ± 6) nmol/L, P ＜ 0. 05, ＜ 0. 01]. There were more intraoperative hypotension cases requiring a continuous application of vasoactive drugs in Group C(37 cases vs 19 cases),total hospital stay(21 ±9 )d vs (23±g)d, P＜0.05] and ICU stay(10±7)dvs (13±9)d, P＜0. 05] were also longer. Postoperative cTn Ⅰ and LVEF of Group Y significantly improved in OPCABG cases ( all P ＜ 0. 05 ). Conclusion The intraoperative application of edaravone in severe elderly patients may prevent MDA increase and SOD decrease and reduce free radical damage. Especially in OPCABG patients,cTn Ⅰ and LVEF improve significantly.