| Objective:To explore the protetive effects of endaravone(MCI-186)and fructose-1,6-diphosphate(FDP) on myocardial ischemia repufusion injury and inflammatory reponse during cardiopulmonary bypass(CPB)in patients underwent cardiovalve replacement.Methods:40 patients with cardiovalve replacement surgey were randomly divided into control group(A group),MCI-186 group(B group),FDP group(C group),MCI-186 plus FDP group(D group),10 in each group.B group received MCI-186 injection 0.5mg/kg in cardioplegia solution during CPB.FDP(200mg/kg)was administered into blood before aortie-clamping in C group.Both edaravone and FDP were administered into blood in D group.Blood samples were taken to measure the activity of superio xide dismulase(SOD)and the levels of malondialdehyde(MDA),creatine kinase-MB and cardinc troponinâ… .The levels of TNF-α,IL-6,IL-8and IL-10 were measured by radioimmunity beforeoperation(T1),aortic-clamping(T2),2h(T3)and 6h(T4)after the aortic declamping,and 24h after the operation(T5).Results:1.There were no significant differences in the four groups in ecumenical thing.2.SODand MDA:The activity of SOD in A,B,C group were significantly lower than the baseline at T2～T4,the lowest was at T2(P＜0.05).But activity of SOD were no diffirence at every point in D group(P＞0.05).The downdrend of A group was much higher than B,C,D groups from T2 to T3(P＜0.05).Plasma levels of MDA in four groups were significantly high than the baseline at T2～T5,the highest was at T4(P＜0.01).Plasma levels of MDA were significantly higher in A group than in the treatment groups from T3 to T4(P＜0.05),there were no diffirence in the treatment groups at the same time(P＞0.05)3.CK-MB and cTnI:â‘ Plasma levels of CK-MB were significantly higher than the baseline at T3～T5 in the four groups,the highest was at T4(P＜0.01),plasma levels of CK-MB were significantly higher in A group than in B,C,D groups at T3～T5(P＜0.05).Increasing amplitude of CK-MB was lower in both B and Cgroup,D group was the lowest.â‘¡Plasma levels of cTnI were significantly higher than the baseline at T2～T5 in the four groups,the highest was at T5(P＜0.01). Plasma levels of cTnI were significantly higher in A group than in the treatment groups at T3 and were significantly higher in A group than in both B and C group at T4,there was no diffirence in the treatment groups at the same time(P＞0.05). Plasma levels of cTnI were significantly higher in A group than in D group at T5 (P＜0.05).4.Plasma levels of CK:â‘ TNF-αwere significantly higher than the baseline at T2～T5,the highest was at T3(P＜0.05).Plasma levels of TNF-αwere significantly higher in A group than in the treatment groups at T3 and T4(P＜0.05),there was no diffirence in the treatment groups at the same time(P＞0.05).â‘¡Plasma levels of IL-6 were significantly higher than the baseline at T2～T4,the highest was at T3(P＜0.05). Plasma levels of IL-6 were significantly higher in A group than in D group at T3 and T4(P＜0.05).There was no diffirence in A,B and Cgroup at the same time (P＞0.05).â‘¢Plasma levels of IL-8 were significantly higher than the baseline at T2～T4,the highest was at T3(P＜0.05).Plasma levels of IL-8 were significantly higher in A group than in B and D group at T2(P＜0.01),there was no diffirence in A and C group at the same time(P＞0.05).Plasma levels of IL-8 were significantly higher in A group than in the treatment groups at T3(P＜0.01).And plasma levels of IL-8 were significantly higher than the baseline at T2～T4,the highest was at T3.â‘£Plasma levels of IL-10 were significantly higher than the baseline at T2～T4,the highest was at T3(P＜0.01).Plasma levels of IL-10 were significantly lower in A group than in C and D group at T3(P＜0.01),there was no diffirence in the treament groups at the same time(P＞0.05).5.In group A,the heart beat conversed automatically in four patients and conversed electrically in six cases,and ventricular tachycardia occurred in three patients,ventricular premature beat appeared in one patient and ventricular fibrillation happened in two cases,and inotropic drug dose was 5.33±0.92(μg/ kg·min).In group B,heart beat conversed automatically in seven patients and was conversed electrically in three cases,and ventricular tachycardia occurred in one case,Dopamine dose was 4.13±0.82(μg/kg·min).In group C,heart beat conversed automatically in six patients and was conversed electrically in four cases,and ventricular tachycardia occurred in one case,.Dopamine dose was 4.56±0.93(μg/ kg·min)。In group D,heart beat conversed automatically in nine patients and was conversed electrically in one case,and no arrhythmia appeared.Dopamine dose was higher in group D than that in group A(P＜0.05).The volume of wound drainage in first postoperative day was less in group D than that in group A(P＜0.05).Conclusion:1.The findings of the present study demonstrated that during peri-CPB stage for atients undergoing cardiac valve replacement,activity of SOD is cutting down,plasma levels of MDA is rising up.And plasma levels of TNF-α,IL-6,IL-8 IL-10 are significantly high.Plasma levels of CK-MB,cTnI are rising up patencyly The evidences indicated that during peri-CPB stage myocardium ischemia reperfusion result in systemic inflammatory response and myocardium and cardiac function was damaged.2.Edaravone and fructose-1.6-diphosphate can inhibit the expression of TNF-α, IL-8 and IL-6 in the patients undergoing mitral valve replacement and can effectively protect myocardium from reperfusion injury during CPB.Moreover, using edaravone plus FDP group is better than using the two medicines separately on myocardial protection during CPB. |
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