摘要
目的探讨依达拉奉联合乌司他丁对心脏瓣膜置换术患者围心肺转流(CPB)期脑保护的作用。方法择期心脏瓣膜置换术患者40例,随机均分为四组。E组于麻醉诱导后静脉滴注依达拉奉0.5 mg/kg,U组于麻醉诱导后静注乌司他丁1.2万U/kg,EU组按照E组和U组的用药量及方法联合给药;C组用等容量生理盐水代替。分别于麻醉后用药前(T0)、主动脉开放后10 min(T1)、4 h(T2)及24 h(T3)采集颈静脉球部血,检测丙二醛(MDA)、超氧化物歧化酶(SOD)、总抗氧化能力(T-AOC)、肿瘤坏死因子α(TNF-α)、白细胞介素(IL)-6、IL-10、神经组织蛋白(S-100β)及神经元特异性烯醇化酶(NSE),并观察术后神经精神并发症的发生情况。结果与C组比较,T1、T2时E、U、EU组TNF-α、IL-6、MDA、S-100β及NSE降低,IL-10、SOD及T-AOC升高(P<0.05);与EU组比较,T1、T2时U组TNF-α、IL-6、MDA、S-100β及NSE均升高,IL-10降低(P<0.05);E组TNF-α、IL-6升高,IL-10降低(P<0.05);与U组比较,T1、T2时E组TNF-α、IL-6升高,IL-10、MDA降低(P<0.05)。术后随访无谵妄及神经系统阳性体征。结论依达拉奉联合乌司他丁用于心脏瓣膜置换术麻醉,有利于抑制炎症因子、氧自由基及其他细胞因子之间网络式的级联放大效应,减轻围CPB期脑损伤;其脑保护效应比单用依达拉奉或乌司他丁更具有优势。
Objective To investigate the effects of edaravone associate with ulinastatin on cerebral protection in patients undergoing cardiac valve replacement under eardiopulmonary bypass （CPB）. Methods Forty patients undergoing selective cardiac valve replacement under CPB were randomly divided into four groups with 10 cases each. In group E, edaravone 0.5 mg/kg was infused in the period of anesthesia induction and thoracotomy. In group U, ulinastatin 12000U/kg was injected IV. In group EU, edaravone associate with ulinastatin were given as in groups of E and U. In group C, isometric normal saline was given instead of edaravone and ulinastatin. Right internal jugular vein was cannulated and the catheter advanced cephalad to the glomus jugulare for blood samples. Gather blood specimen and the plasma concentrations of MDA,TNF-α, IL-6, IL-10, S-100β protein,NSE and SOD, T-AOC activity were measured at the time between the period of anesthesia induction and administration（T0 ）, 10 min after aortic unclamping （T1）, 4 h （T2） and 24 h （T3）. Postoperative neuropsychological complications were observed. Results Compared to group C, at T1 , T2 plasma concentrations of TNF-α, IL-6, MDA, S-100β protein and NSE were lower, and IL-10, SOD and T- AOC were higher in groups of E,U and EU（P〈0. 05）. Compared to group E, plasma concentrations of TNF-α, IL-6 were lower, MDA and IL-10 were higher in group U,TNF-α, IL-6, S-100β protein and NSE were lower, IL-10 was higher in group EU（P〈0. 05）. Compared to group U, TNF-α, IL-6, MDA, S-100β protein and NSE were lower, IL-10 was higher in group EU（P〈0. 05）. No delirium and neural positive signs were appeared. Conclusion Compared with use of edaravone or ulinastatin alone, edaravone combined with ulinastatin has better efficacy in alleviating brain injury in patients undergoing cardiac valve replacement under CPB by restraining cascade amplification among inflammatory faetors,oxyradica and cytokines.
出处
《临床麻醉学杂志》
CAS
CSCD
北大核心
2010年第7期583-586,共4页
Journal of Clinical Anesthesiology
基金
贵州省卫生厅科学技术基金(gzwkj2008-1-016)
关键词
依达拉奉
心脏瓣膜置换术
心肺转流
脑保护
Edaravone
Cardiac valve replacement
Cardiopulmonary bypass
Brain protection
