Department of Cardiovascular Surgery, University of Fatih, Faculty of Medicine, Ankara, Turkey.
Cardiovasc Pathol. 2013 Sep-Oct;22(5):368-72. doi: 10.1016/j.carpath.2013.02.001. Epub 2013 Mar 13.
N-acetylcysteine (NAC), a precursor of reduced glutathione, has been in clinical use primarily as a mucolytic. In addition, NAC is well known for their free radical scavenging and antioxidant properties. Increasing of reactive oxygen products occurring during cardiac surgery can play an important role in postoperative adhesion formation. We investigated to the efficacy of the NAC for postoperative pericardial adhesions.
Sixteen New Zealand white rabbits (2.5-3 kg) were used and categorized into two groups including study (use of NAC) and control groups. In both groups, the pericardium was opened longitudinally, and the exposed epicardial surfaces were abraded with dry gauze. The rabbits were divided into two groups: Group 1 was treated with the sponge, which impregnated with NAC solution, (10%, 300 mg/3 ml) and applied over the abraded epicardium for 5 min (n=8). Group 2 was the control, and the sponge, which was impregnated with 3-ml isotonic NaCl solution (0.9%), was applied onto the surface of the abraded epicardium for 5 min (n=8). After a period of 2 weeks, the animals were sacrificed. The scores of adhesion were graded by macroscopic examination, and the pericardial tissues were analyzed microscopically in point of inflammation and fibrosis.
In Group 1, the adhesion scores were significantly lower compared with the control group [Group 1 vs. 2; 1 (1-2) vs. 3 (2-3), P<.001]. No significant difference was found between the groups in terms of the severity of inflammation [Group 1 vs. 2; 1.5 (1-3) vs. 2.5 (1-3), P=.083]. There was a difference between groups in terms of the degree of fibrosis [Group 1 vs. 2; 2 (1-2) vs. 3 (2-3), P=.007].
The use of NAC for preventing postoperative pericardial adhesions was reduced to adhesion and fibrosis scores in an experimental rabbit model. There was no statistically significant difference between groups in terms of inflammatory scores. The NAC effectively prevented the formation of pericardial adhesion.
N-乙酰半胱氨酸（NAC）是还原型谷胱甘肽的前体，主要作为黏液溶解剂在临床上使用。此外，NAC 还以其清除自由基和抗氧化特性而闻名。心脏手术过程中产生的活性氧产物的增加可能在术后粘连形成中起重要作用。我们研究了 NAC 对术后心包粘连的疗效。
使用 16 只新西兰白兔（2.5-3 公斤），分为研究（使用 NAC）和对照组。两组均将心包纵向切开，用干纱布擦拭暴露的心外膜表面。兔子分为两组：第 1 组用浸透 NAC 溶液（10%，300mg/3ml）的海绵处理，将其涂在擦拭过的心外膜表面 5 分钟（n=8）。第 2 组为对照组，将浸透 3ml 等渗生理盐水（0.9%）的海绵涂在擦拭过的心外膜表面 5 分钟（n=8）。2 周后，处死动物。通过宏观检查对粘连程度进行评分，并从炎症和纤维化的角度分析心包组织的微观变化。
第 1 组的粘连评分明显低于对照组[第 1 组与第 2 组比较；1（1-2）与 3（2-3），P<.001]。两组炎症严重程度无显著差异[第 1 组与第 2 组比较；1.5（1-3）与 2.5（1-3），P=0.083]。两组纤维化程度存在差异[第 1 组与第 2 组比较；2（1-2）与 3（2-3），P=0.007]。
在实验兔模型中，使用 NAC 预防术后心包粘连可降低粘连和纤维化评分。两组间炎症评分无统计学差异。NAC 可有效预防心包粘连形成。
