Protective effect of nicorandil on myocardial ischemia reperfusion injury in patients undergoing cardiac valve replacement

Abstract

Abstract: AIM: To observe the protective effect of nicorandil on myocardial ischemia reperfusion injury in patients undergoing valve replacement. METHODS: Sixty patients undergoing valve repalacement were randomly divided into 3 groups: control(Ⅰ) group, nicorandil delayed precondictioning(Ⅱ) group and nicorandil preconditioning(Ⅲ) group. 20 mg nicorandil was given i.v. 24 h before operation in group Ⅱ, whereas in group Ⅲ, 20 mg nicorandil was given i.v. after induction of anesthesia. Blood samples were taken from coronary venous for determination of cTnI, TNF-α, IL-6 levels at aortic clamping (T₀), 15 min (T₁), 30 min(T₂), 60 min (T₃), 90 min(T₄) after aortic declamping. Right atria myocardium tissue were taken at T₀ and T₂ to observe the histopathological changes with electron microscopy. RESULTS: The levels of cTnI, TNF-αand IL-6 in group Ⅱand Ⅲ were significantly lower than those in group I. Myocardium injury was obviously lighter in groupⅡand Ⅲ than that in group Ⅰ, whereas the levels of cTnI, TNF-α, IL-6 and myocardium injury were lower in group Ⅱ than those in group Ⅲ. CONCLUSION: Nicorandil is effcetive in decreasing myocardial ischemia repefusion injury in patients undergoing valve replacement, The protective effect of nicorandil delayed preconditioning is more obvious than precondictioning.

Key words: Nicorandil, Heart valve replacement, Implantation, Myocardial protection

CLC Number:

R614

LIU Liu, ZHOU Hai-yang, WANG Jian-bin, LU Zhi-ping. Protective effect of nicorandil on myocardial ischemia reperfusion injury in patients undergoing cardiac valve replacement[J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2010, 15(3): 322-325.

References

[1] 刘流,陈启智,谢才姣,等.强力宁与甘利欣对心内直视手术患者血清肌酶及心脏复苏的影响[J].临床麻醉学杂志,2001,17(5):7-9.
[2] 张军,徐瑞好,张健,等.参附注射液预先给药对体外循环下瓣膜置换术患者心肌的保护作用[J].中华麻醉学杂志,2009,29(10):877-880.
[3] 董振明,罗友军,康荣田,等.尼可地尔预先给药对心肌缺血再灌注免心肌细胞凋亡的影响[J].中华麻醉学杂志,2005,25(10):747-750.
[4] 钱巧慧,郭佳勇,钟敏章.钾通道开放剂尼可地尔在心肌缺血中的作用[J].世界临床药物,2002,23(6):717-720.
[5] Yasuda T,Hashimana K,Mastsntra Y,et al. Nicorandial,a hybrid between mitrate and ATP-sensitive potassiam channel opener,penconditious,human heart to ischemia during percutameaus treusluminal coronany angioplasty J[J]. Jpn Cire J,2001,65(6):526-530.
[6] Symons JA,Myles PS.myocandial protection with volatile anaesthetic agents during coronary artery bypass Surgery:a meta-analysis[J]. Br J Anaesth, 2006,97(1):127-136.
[7] Danton GH,Dietrich WD.Inflammatory mechanisms after ischemia and stroke[J]. J Neuropathol Exp Neurol, 2003,62(1):127-136.
[8] Li J,Zhang H,Wu F,et al.Insnlin inhibits tumor necnosis factor-alpha indution in myocardial ischemia/reperfusion: role of Akt and endothelial nitric oxide synthase phosporylation[J]. Crit Care Med, 2008,36(9):1551-1558.
[9] Frangogiannis WG,Smith CW,Entman ML. The inflammatory response in mycardial in farction[J]. Cardivoasc Kes, 2002,53(1): 31-47.
[10]郑勇萍,王焱林,王成夭.异丙酚对大鼠缺血再灌注心肌Toll样受体4,NF-kB及血清IL-6的影响[J].中华麻醉学杂志,2007,27(7):714-716.
[11]孙春玲,洪华山.细胞因子对急性心肌梗死的心肌修复作用[J].中国临床药理学与治疗学,2006,9(11):1213-1215.
[12]章志伟,陈昕,李玉宏,等.心肌声学造影评价钾离子通道开放剂延迟性心肌保护作用[J].中国超声医学杂志,2007,24(1):13-16.