摘要
目的观察N-乙酰半胱氨酸(NAC)对冠状动脉旁路移植术(CABG)患者术后早期再灌注损伤和急性氧化应激的影响。方法本研究为前瞻性随机对照临床试验。选择2016年1月~2019年12月接受CABG的患者90例(ASAⅡ~Ⅲ级,心功能Ⅱ~Ⅲ级),采用随机数字表法分为对照组(C组,n=45)和NAC组(N组,n=45)。N组患者术前5天连续静脉给予2400 mg的NAC,C组患者术前5天连续静脉给予等量的生理盐水。在患者给予NAC或生理盐水前(T0)、手术结束时(T_(1))、手术结束后1小时(T_(2))、手术结束后6小时(T_(3))以及手术结束后12小时(T_(4))测定血清心肌肌钙蛋白I(cTnI)、肌红蛋白、肌酸激酶同工酶(CK-MB),乳酸、丙二醛(MDA)和肿瘤坏死因子-α(TNF-α)的水平。观察术后两组患者的气管拔管时间、机械通气时间、ICU停留时间和住院时间。结果与C组相比,N组患者的cTnI、肌红蛋白、CK-MB、乳酸和TNF-α在T_(1)至T_(4)时间点均显著降低(均P<0.05),N组患者的MDA在T_(3)至T_(4)时间点显著降低(均P<0.05)。与C组相比,N组患者的气管拔管时间、机械通气时间显著缩短(P<0.05),ICU停留时间和住院时间比较差异无统计学意义(P>0.05)。结论术前使用NAC能减轻CABG患者术后早期氧化应激引起的相关心肌再灌注损伤。
Objective To identify the effect of N-acetyl cysteine(NAC)in reducing early reperfusion injury and acute oxidative stress in patients undergoing coronary artery bypass grafting(CABG).Methods In this clinical randomized double-blind controlled trial,90 patients(American Society of AnesthesiolostsⅡ-Ⅲ,cardiac function gradeⅡ-Ⅲ)underwent elective CABG were enrolled.Patients were randomly divided into the control group(group C,n=45)and the NAC group(group N,n=45).Patients in group N received NAC 2400mg for five consecutive days before surgery,while patients in group C received normal saline.Blood samples were withdrawn from arterial line,before the induction of anesthesia(T0),at the end of the surgery(T_(1)),1 hour after the surgery(T_(2)),6 hour after the surgery(T_(3))and 12 hour after the surgery(T_(4)).The blood samples were analyzed for cTnI,Myo,CK-Mbmass,lactate,MDA and TNF-αlevels,time to extubation,days of mechanical ventilation,length of ICU and hospital stay.Results Compared with group C,cTnI,myoglobin,CK MB,lactic acid and TNFαin group n were significantly lower at t 1 to t 4 time points(all P<0.05),and MDA in group N was significantly lower at t 3 to t 4 time points(all P<0.05).Compared with group C,the extubation time and mechanical ventilation time of group n were significantly reduced(P<0.05),but there was no significant difference in ICU stay and hospital stay(P>0.05).Conclusion Preoperative use of NAC can reduce myocardial reperfusion injury caused by early oxidative stress in patients with CABG.
作者
王涵
冯艳
伍志超
袁卫国
刘仕强
王永杰
WANG Han;FENG Yan;WU Zhichao;YUAN Weiguo;LIU Shiqiang;WANG Yongjie(Departmentof Anesthesiology, Nanchong Central Hospital, Nanchong 637000, Sichuan, China;Department of Cardiothoracic Surgery, Nanchong Central Hospital, Nanchong 637000, Sichuan, China)
出处
《西部医学》
2021年第3期435-439,共5页
Medical Journal of West China
基金
四川省卫计委科研课题(18PJ183)。
