تأثیر داروی ان-استیل سیستئین در محلول پرایم بر کاهش آسیب به میوکارد در جراحی قلب باز

نوع مقاله : Original Article(s)

نویسندگان

1 استادیار، گروه جراحی، دانشکده‌ی پزشکی، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران

2 کارشناس ارشد تکنولوژی گردش خون، دانشکده‌ی پزشکی، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران

10.48305/jims.v41.i749.1099

چکیده

مقاله پژوهشی




مقدمه: بای‌پس قلبی- ریوی و آسیب خون‌رسانی مجدد منجر به آزاد شدن رادیکال‌های آزاد و واسطه‌های التهابی می‌گردد. استفاده از آنتی‌اکسیدان‌ها حین بای‌پس قلبی- ریوی، به یک استراتژی برای نجات میوکارد از حمله‌ی این رادیکال‌ها تبدیل شده است. هدف از این پژوهش، بررسی اثر ان-استیل سیستئین (N-acetyl cysteine) NAC بر کاهش آسیب به میوکارد ناشی از رادیکال‌های آزاد بود.
روش‌ها: در یک کارآزمایی بالینی، 40 بیمار کاندید جراحی پیوند کرونر جهت دریافت داروی ان- استیل سیستین در محلول پرایم، به طور تصادفی به 2 گروه مداخله و شاهد تقسیم شدند. در گروه مداخله به محلول پرایم، NAC اضافه گردید و در گروه شاهد حجم معادل از دارونما (نرمال‌سالین) تجویز شد. میزان تروپونینI (cTnI) و CRP به صورت کمی، نیاز به شوک و pace maker و مدت زمان اقامت در ICU در هر دو گروه بررسی و مقایسه گردید.
یافته‌ها: بیماران دو گروه از نظر سن، جنس، نیاز به دفیبریلاتور، کسر جهشی، مدت زمان پمپ و کلمپ آثورت تفاوت معنی‌داری نداشتند. میانگین تروپونین، 8 ساعت پس از جراحی در گروه مداخله و شاهد به ترتیب 1/84 ± 5/05 و 1/60 ± 10/37 و میانگین CRP  24 ساعت بعد ازعمل به ترتیب 7/45 ± 28/47 و 5/74 ± 55/18 بود. میانگین اقامت در (Intensive care units) ICU در گروه مداخله و شاهد به ترتیب 51/73 ± 10/9 و 55/78 ± 13/5 بود و تفاوت معنی‌داری دیده نشد.
نتیجه‌گیری: نتایج این مطالعه نشان داد، استفاده از NAC موجب کاهش CRP  و cTnI پس از عمل جراحی قلب باز گردید که گویای اثر آنتی‌اکسیدانی و ضدالتهابی آن بر میوکارد می‌باشد.

تازه های تحقیق

مهران شاه زمانی: Google Scholar, PubMed

علیرضا حسینی: Google Scholar, PubMed

کلیدواژه‌ها

موضوعات


عنوان مقاله [English]

The Effect of N-acetylcysteine in Prime Solution on Reducing Damage to the Myocardium in Open Heart Surgery

نویسندگان [English]

  • Mehran Shahzamani 1
  • Alireza Hoseini 1
  • Bahareh Baharifar 2
1 Assistant Professor, Department of Surgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
2 MSc in Circulatory Technology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
چکیده [English]

Background: Cardiopulmonary bypass and reperfusion injury lead to the release of free radicals and inflammatory mediators during surgery. The use of antioxidants during cardiopulmonary bypass has become a strategy to save the myocardium from the attack of these radicals. This study aimed to investigate the effect of N-acetyl cysteine on reducing damage to the myocardium caused by free radicals.
Methods: In a randomized clinical trial, 40 patients who were candidates for vascular graft surgery to receive
N-acetyl cysteine in Prime solution were randomly divided into two intervention and control groups. In the intervention group, N-acetyl cysteine was added to the prime solution, and in the control group, an equivalent volume of placebo (normal saline) was administered. The levels of Troponin I and C-reactive protein, the need for shock and pacemaker, and the length of stay in the Intensive Care Unit were investigated and compared in both groups.
Findings: The patients of both groups did not have significant differences in terms of ages, sex, ejection fraction, duration of the pump, and Athort clamp. Average troponin 8 hours after surgery in the intervention and control groups were 60.5 ± 1.84 and 5.05 ± 1.84 respectively. 10.37 ± 1.0 and the average CRP 24 hours after the operation was 28.47 ± 7.45 and 55.18 ± 5.74, respectively. The need for a defibrillator was not significantly different between the two groups (P < 0.05). The average length of stay in the intensive care unit in the intervention and control groups was 51.73 ± 10.9 and 55.78 ± 13.5, respectively, and no significant difference was seen.
Conclusion: The results show that the use of NAC decreases CRP and cTnI after open heart surgery, which shows its antioxidant and anti-inflammatory effect on the myocardium.

کلیدواژه‌ها [English]

  • Anti-inflammatory agents
  • Antioxidants
  • Cardiopulmonary bypass
  • N-acetyl cysteine
  • Oxidative stress
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