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

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

مراجع

  1. Suleiman MS, Halestrap AP, Griffiths EJ. Mitochondria: a target for myocardial protection. Pharmacol Ther 2001; 89(1): 29-46.
  2. Hiyama A, Takeda J, Kotake Y, Morisaki H,
    Fukushima K. A human urinary protease inhibitor (ulinastatin) inhibits neutrophil extracellular release of elastase during cardiopulmonary bypass. J Cardiothorac Vasc Anesth 1997; 11(5): 580-4.
  3. Sochman J. N-acetylcysteine in acute cardiology: 10 years later: what do we know and what would we like to know?! J Am Coll Cardiol 2002; 39(9): 1422-8.
  4. Khan SA, Campbell AM, Lu Y, An L, Alpert JS, Chen QM. N-Acetylcysteine for cardiac protection during coronary artery reperfusion: a systematic review and meta-analysis of randomized controlled trials. Front Cardiovasc Med 2021; 8: 752939.
  5. Raghu G, Berk M, Campochiaro PA, Jaeschke H, Marenzi G, Richeldi L, et al. The multifaceted therapeutic role of N-Acetylcysteine (NAC) in Disorders Characterized by Oxidative Stress. Curr Neuropharmacol 2021; 19(8): 1202-24.
  6. Zakkar M, Guida G, Suleiman MS, Angelini GD. Cardiopulmonary bypass and oxidative stress. Oxid Med Cell Longev 2015; 2015: 189863.
  7. Raedschelders K, Ansley DM, Chen DDY. The cellular and molecular origin of reactive oxygen species generation during myocardial ischemia and reperfusion. Pharmacol Ther 2012; 133(2): 230-55.
  8. McCarthy CP, Raber I, Chapman AR, Sandoval Y, Apple FS, Mills NL, et al. Myocardial Injury in the Era of High-Sensitivity Cardiac Troponin Assays: A Practical Approach for Clinicians. JAMA Cardiol 2019; 4(10): 1034-42.
  9. Xiang M, Lu Y, Xin L, Gao J, Shang C, Jiang Z, et al. Role of oxidative stress in reperfusion following myocardial ischemia and its treatments. Oxidative Medicine and Cellular Longevity 2021; 2021: 6614009.
  10. D’Oria R, Schipani R, Leonardini A, Natalicchio A, Perrini S, Cignarelli A, et al. The role of oxidative stress in cardiac disease: from physiological response to injury factor. Oxid Med Cell Longev 2020; 2020: 5732956.
  11. El-Hamamsy I, Stevens LM, Carrier M, Pellerin M, Bouchard D, Demers P, et al. Effect of intravenous N-acetylcysteine on outcomes after coronary artery bypass surgery: a randomized, double-blind, placebo-controlled clinical trial. J Thorac Cardiovasc Surg 2007; 133(1): 7-12.
  12. Huang H, Yin R, Zhu J, Feng X, Wang C, Sheng Y, et al. Protective effects of melatonin and N-acetylcysteine on hepatic injury in a rat cardiopulmonary bypass model. J Surg Res 2007; 142(1): 153-61.
  13. He F, Zheng G, Hou J, Hu Q, Ling Q, Wu G, et al. N-acetylcysteine alleviates post-resuscitation myocardial dysfunction and improves survival outcomes via partly inhibiting NLRP3 inflammasome induced-pyroptosis. J Inflamm (Lond) 2020; 17: 25.
  14. Faghfouri AH, Zarezadeh M, Tavakoli-Rouzbehani OM, Radkhah N, Faghfuri E, Kord-Varkaneh H, et al. The effects of N-acetylcysteine on inflammatory and oxidative stress biomarkers: A systematic review and meta-analysis of controlled clinical trials. Eur J Pharmacol 2020; 884: 173368.
  15. Abdel-Wahab WM, Moussa FI. Neuroprotective effect of N-acetylcysteine against cisplatin-induced toxicity in rat brain by modulation of oxidative stress and inflammation. Drug Des Devel Ther 2019; 13: 1155-62.
  16. Menasché P, Grousset C, Gauduel Y, Mouas C, Piwnica A. Maintenance of the myocardial thiol pool by N- An effective means of improving cardioplegic protection. J Thorac Cardiovasc Surg 1992; 103(5): 936-44.
  17. Wang G, Bainbridge D, Martin J, Cheng D. N-acetylcysteine in cardiac surgery: do the benefits outweigh the risks? A meta-analytic reappraisal. J Cardiothorac Vasc Anesth 2011; 25(2): 268-75.
  18. Nozari Y, Eshraghi A, Talasaz AH, Bahremand M, Salamzadeh J, Salarifar M, et al. Protection from Reperfusion Injury with Intracoronary N-Acetylcysteine in Patients with STEMI Undergoing Primary Percutaneous Coronary Intervention in a Cardiac Tertiary Center. Am J Cardiovasc Drugs 2018; 18(3): 213-21.
  19. Sucu N, Cinel I, Unlu A, Aytacoglu B, Tamer L, Kocak Z, et al. N-acetylcysteine for preventing pump-induced oxidoinflammatory response during cardiopulmonary bypass. Surg Today 2004; 34(3): 237-42.
  20. Rostami AR, Sharifi M, Kamali AR, Kalantari M. Evaluation of the effect of combination of n-acetylcysteine and vitamin c on improving outcomes following CABG [in Persian]. J Arak Univ Med Sci 2016; 18(10): 29-39.
  21. Aghadavoudi O, Fatahi F. The cardioprotective effects of n acetylcysteine as an additive to the blood cardioplegia during coronary artery bypass grafting [in Persian]. J Kerman Univ Med Sci 2008; 15(3): 225-33.
مجله دانشکده پزشکی اصفهان
دوره 41، شماره 749
هفته 1، اسفند
بهمن و اسفند 1402
صفحه 1140-1146

فایل ها

هم رسانی

ارجاع به این مقاله

آمار