体外循环下冠状动脉旁路移植术患者尼可地尔术前用药的心肌保护作用

目的 评价尼可地尔术前用药对体外循环(CPB)下冠状动脉旁路移植术(CABG)患者的心肌保护作用.方法 择期CPB下CABG患者30例,年龄45～64岁,体重45～90 kg,ASAⅡ或Ⅲ级.随机分为2组(n=15):对照组(C组)和尼可地尔组(N组).N组麻醉前30 min口服尼可地尔10 mg,C组麻醉前不给予尼可地尔.于手术开始时(T1)、停CPB后即刻(T2)、30 min(T3)、60 min(T4)、术毕(T5)时记录HR、MAP、平均肺动脉压(MPAP)、肺毛细血管楔压(PCWP)、中心静脉压(CVP)和心排血量(CO),计算每搏指数(SI)、左室每搏功指数(LVSWI)、右室每搏功指数(RVSWI)、周围血管阻力(SVR)和肺血管阻力(PVR).于麻醉诱导前(T0,基础状态)、T3、术后6 h(T6)、24 h(T7)时采集静脉血样8ml,采用ELLSA法测定血清心肌肌钙蛋白Ⅰ(cTnⅠ)浓度.结果 与C组比较,N组T7时血清cTnⅠ浓度降低(P<0.05).与基础值比较,C组其余各时点血清cTnⅠ浓度升高(P<0.01),N组其余各时点血清cTnI浓度差异无统计学意义(P>0.05).与C组比较,N组SVR降低(P<0.05),其余血液动力学指标差异无统计学意义(P>0.05).结论 术前30 min口服尼可地尔10 mg对体外循环下冠状动脉旁路移植术患者具有一定程度的心肌保护作用.

Myocardial protective effect of nicorandil premedication In patients undergoing coronary artery bypass grafting with cardiopulmonary bypass

Objective To evaluate the myocardial protective effect of nicorandil premedication in patients undergoing coronary artery bypass grafting with cardiopulmonary bypass (CPB). Methods Thirty ASA Ⅱ or Ⅲ patients aged 45-64 yr weighing 45-90 kg undergoing coronary artery bypass grafting under cardiopulmonary bypass were randomized into 2 groups (n = 15 each): nicorandil group (N) and control group (C). The patients received nieorandil 10 mg orally 30 min before induction of anesthesia in group N, but the patients received no nicorandil before induction of anesthesia in group C. HR, MAP, mean pulmonary arterial pressure (MPAP), pulmonary capillary wedge pressure (PCWP), central venous pressure (CVP) and cardiac output (CO) were recorded and stroke index (SI), left ventricular stroke work index (LVSWI), right ventriculur stroke work index (RVSWI),systemic vascular resistance (SVR) and pulmonary vascular resistance (PVR) were determined at the beginning of operation (T1), immediately after termination of CPB (T2), 30 min (T3) and 60 min (T4) after CPB and at theend of operation(T5). Venous blood samples were taken before the induction of anesthesia (To, baseline), at T3and at 6 h (T6) and 24 h (T7) after operation for determination of serum concentration of cardiac tropin Ⅰ (cTnⅠ)by ELISA. Results Serum cTnⅠ concentration was significantly lower at T7 in group N than in group C (P <0.05). Serum cTnⅠ concentration was significantly increased at the other time points in group C (P<0.01), but there was no significant change in serum cTnⅠ concentration at the other time points in group N as compared with the baseline value(P>0.05). SVR was significantly lower in group N than in group C (P<0.05), but there was no significant difference in the other hemodynamic parameters between the two groups (P>0.05). Conclusion Nieorandil 10 mg premedicated orally 30 min before the operation exerts myocardial protective effect in patients undergoing coronary artery bypass grafting with eardiopulmonary bypass.