The Clinical Study Of Myocardial Protective Effect Of Edaravone In Patients With Valve Replacement

Objective:To investigate the myocardial protection effect of edaravone(MCI-186)in patients with valve replacement, thereby providing a new clinical management to cardiac surgery and other important organs which undergoing ischemic reperfusion injury.Methods:Forty patients with rheumatic heart disease undergoing cardiac valve replacement were randomly divided into two groups.MCI-186 group(group M,n=20)received edaravone injection 0.5mg/kg in venous blood reservoir of cardiopulmonary bypass unit at 10 min before declamping aorta,Control group(group C,n=20)did not receive edaravone.Hemodynamic parameters were recorded before skin incision(T1),at 2h(T2), 8h(T4)and 24h(T6)after declamping aorta;blood samples were taken before T1,at T4,16 h(T5)and 72h(T7)after declamping aorta for determination of TBIL,AST,ALT,BUN,Cr,CK-MB,Myo, cTn I,and before T1,at 4h(T3),at T4,at T5,at T6 after declamping aorta for MDA;the myocardial tissues were taken from right atrium for observing ultrastructural changes;meanwhile, the clinical effectiveness of the two groups was observed.Results:①There were no statistical differences for the levels of MAP and HR between the two groups(P＞0.05).The levels of PAWP at T6 in group M were lower than those in group C(P ＜0.05).In the two groups the levels of CI increased at T2, T4 and T6,and in group M were higher than those in group C at T2(P＜0.01),T4(P＜0.05)and T6(P＜0.01).The levels of SVI and LVSWI at T6 in group M were higher than those in group C(P＜0.05).②After declamping aorta,the levels of CK-MB. Myo.cTn I at T4,T5 in group M were lower than those in group C(P＜0.01).③There were no statistical differences to the levels of TBIL,AST,ALT,BUN and Cr between the two groups(P＞0.05), and the levels of BUN and Cr were always normal atT1,T4,T5 and T7 in the two groups.The levels of TBIL,AST and ALT recovered at T7 in the two groups.④The levels of MDA in group M were lower than in group C at all time points after declamping aorta(P＜0.01).⑤After declamping aorta,the spontaneous return rate was 75%in group C and 90%in group M.The amount of positive inotropic drugs in group M was less than group C(P＜0.05)⑥After ischemia reperfusion,myocardial cellular mitochondria and intercalary disc of group M were in almost normal morphology. However,conspicuous disorganization of myocardial cellular ultrastructure could be seen group C.The myocardial mitochondria lesion after ischemic reperfusion measured by Flameng's semiquantitative analysis in group C was more serious than of group M(P＜0.05)Conclusion:(1)Before reperfusion,MCI-186 can decrease the production of MDA in order to reduce myocardium ischemic reperfusion injury if supplied in time.(2)MCI-186 can improve hemodynamic condition andfunction of left ventricle,and degrade preload of right ventricle;and has no significant disadvantage effects on hepatic and renal function.(3)MCI-186 can lessen the myocardial mitochondria lesion,which promote cardiac function recovery.The mechanism might be associated with that MCI-186 can scavenge free radicals.