The Clinical Research Of Edaravone On Pulmonary Protection In Patients Undergoing On-Pump Beating Heart Surgery

Objective To investigate the effect of edaravone on pulmonary protection in patients undergoing on-pump beating heart surgery.Mothod Sixty patients with rheumatic heart disease undergoing mitral valve replacement were divided into two groups:experimental group(group E,n=30),patients received edaravone injection 0.5mg/kg in circuit priming fluids;control group(group C,n=20),patients received equal volume of normal saline.Blood samples were taken for determination of PolymorPhonuclear leukocyte(PMNs),Lymphocyte and platelet count at six different time intervals(preoperation,30 minutes after CPB,the end of CPB,postoperation,24 hours after postoperation,72 hours after postoperation);C3,IL-6,IL-8 and TNF-αwere respectively measured at six different time intervals in blood(preoperation,30 minutes after CPB,the end of CPB,postoperation,24 hours after postoperation,72 hours after postoperation);Peak airway pressure,plat airway pressure,tidal volume were recorded and arterial blood gas was analyzed at four different time intervals(preoperation,the end of CPB,1 hour after CPB,postoperation).Calculate the results of dynamic lung compliance,alveolar-arterial oxygen difference and oxygenation index.Lung biopsies were obtained at two time intervals(the time of sternotomy and the end of CPB)Results (1)In both groups PMNs count in blood were increased from the beginning of CPB,Reached peak at 24 hours after postoperation, declined from the time of 72 hours after postoperation and restored to normal;lymphocyte count in blood were declined from the beginning of CPB,Reached trough at postoperation,elevated from the time of 24 hours after postoperation,but it is still lower than before at the time of 72 hours after postoperation;Platelet count in blood were declined from the beginning of CPB,Reached trough at the end of CPB,elevated slowly from the time of postoperation,but it is still lower than before at the time of 72 hours after postoperation (2)The concentrations of plasma C3 in both groups were declined from the beginning of CPB,Reached trough at postoperation,elevated from the time of 24 hours after postoperation,restored to normal at the time of 72 hours after postoperation.there is no Statistical difference between groups(p>0.05);The levels of plasma inflammatory cytokines(IL-6,IL-8 and TNF-α) in both groups were elevated from the beginning of CPB,reached peak at postoperation,declined from the time of 24 hours after postoperation,restored to normal at the time of 72 hours after postoperation.The levels of experimental group were lower than control group(p<0.01).(3)Peak airway pressure,plat airway pressure and alveolar-arterial oxygen difference were elevated from the beginning of operation,and dynamic lung compliance,oxygenation index were declined.The results of experimental group were superior to control group(p<0.01).(4) The light microscopic analyses showed hyperemia and hemorrhages in the capillaries in the control group after CPB.Alveolar exudate was obvious,and neutrophils were seen in the capillary of the alveolar wall and the alveolar space.The lung biopsy of experimental group showed well-preserved alveolar structure with slightly alveolar exudate and few neutrophils accumulation in alveolus.Conclusion Edaravone can degrade the degree of SIRS,soften the injury to lung tissue,have the ability to protect lung function.The mechanism maybe is to scaveng the excessive ROS(reactive oxygen species)and reduce the inflammtory cytokines producted in vivo.