Effects Of Edaravone In Patients Undergoing Cardiac Valve Replacement Under Cardiopulamonary Bypass

Objective To investigate the effects of the free radical scavenger edaravone under cardiopulmonary bypass(CPB) and the effects of edaravone in valve replacement surgery under CPB on cardiac and cerebral protection. To observe the complications when edaravone use in CPB.Methods Thirty patients undergoing mitral or(and) aortic valve replacement(MVR or AVR) under CPB from March,2009 to December in our hospital were selected, and were divided into two groups by means of random number table:experiment group(14 cases) and control group(16 cases). Inclusion criteria:①patients received valve replacement surgey under CPB;②age:20-65;③heart function:Ⅰ～Ⅲclass;④liver, kidney and lung function proerly;⑤blood gas and electrolyte properly. Exclude criteria:①preoperatively used scavenger and the like;②there is history of cerebrovascular or neuropsychiatric symptoms;③has history of myocardial infarction or other coronary artery disease. In experiment group 0.5 mg/kg of edaravone was diluted to 20 ml and given in CPB at the begin of CPB, while the same dose of saline water was given in control group in the same way. Blood samples were collected from radial artery at five time points:the begin of CPB(T0), the end of CPB(T1,30min(T2),6h(T3),24h(T4) after CPB. Two copies of blood samples were collected:one for determination of hematocrit(HCT), the other was centrifuged by 3800 r/min, serum was collected and kept in-20℃refrigeratory. After all cases were collected, to defrost all serum samples and detect the levels of malondialdehyde(MDA), inducible nitric oxide synthase(iNOS), cardiac troponin I(cTnI), creatine kinase-MB(CK-MB), Myoglobin(Myo), S-100 protein, neuron-specific enolase(NSE). To compare the levels of HCT, MDA, iNOS, cTnI, CK-MB, Myo, S100, NSE in two groups and between the groups. To observe the way of cardiac resuscitation and critically postoperative complications.Results Except cTnI at T4 in experiment group was lower than that in control group (P<0.05), there were no obvious differences of MDA,iNOS,CK-MB,Myo,NSE,S100 protein between two groups (P>0.05). The MDA of two groups were higher at T0 than that at T2 point(P< 0.05), cTnI, CK-MB were higher at T0 than that at T1-4 point(P<0.05), and reached the peak at T3, but Myo reached the peak at T1, latter, drop gradually.The levels of NSE, S100 proteins in two groups reached the peak at T1, NSE was higher at T1～3 than that at T0, and S100 protein was higher at T1,T2 than that at T0, while it was lower at T3, T4 than that at T0 (P< 0.05). There was no obvious differences of cardiac resuscitation between two groups (P>0.05). In experiment group the levels of HCT at T1-3 were lower than that in control group, and one case was found have acute kidney failure.Conclusion There is no obvious free radical scavenging ability and cardiocerebral protection of edaravone in cardiac valve replacement surgery under cardiopulmonary bypass, even accompanied by some complications, such as acute kidney failure, erythrocytes decrease, and so on.It needs more study for the use of edaravone in CPB,and we must be careful if we use it in CPB.