地尔硫䓬对心肺转流下冠状动脉旁路移植术患者左心室功能的影响

目的探究小剂量地尔硫在心肺转流(CPB)下冠状动脉旁路移植术(CABG)术中应用是否产生抗动脉痉挛作用及左心室负性肌力作用。方法选择择期行CPB下CABG患者43例,男27例,女16例,年龄45~79岁,BMI 18~30 kg/m²,ASAⅡ或Ⅲ级,NYHAⅡ或Ⅲ级,术前左心室射血分数(LVEF)≥45%。随机分为两组:地尔硫组(D组)和对照组(C组),术中均采用全凭静脉麻醉。在置入经食管超声心动图(TEE)探头后,D组静脉输注地尔硫0.5μg·kg^-1·min^-1,C组给予生理盐水,均连续静脉输注至手术结束。在置入TEE探头即刻(T 0)、置入TEE探头后30 min(T₁)、CPB断流20 min(T₂)、50 min(T₃)采用TEE探头采集心脏超声图像,通过斑点追踪技术(STI)离线处理图像,分析并记录左心室功能STI指标:整体纵向应变力(GLS)、整体环向应变力(GCS)、整体纵向达峰时间标准差(GLTSD)、整体环向达峰时间标准差(GCTSD);同时记录传统心功能指标:CI及LVEF;记录左侧乳内动脉桥(LIMA)血流及术后房颤(POAF)发生率、呼吸支持时间、ICU停留时间及总住院时间等术后恢复指标。结果两组不同时点左心室收缩功能及运动同步化指标GLS、GCS、GLTSD、GCTSD差异无统计学意义;两组CI、LVEF差异无统计学意义。D组LIMA血流量高于C组(P<0.05);D组术后6 h cTnI浓度明显低于C组(P<0.05),两组POAF发生率、呼吸支持时间、ICU停留时间及总住院时间差异无统计学意义。结论小剂量地尔硫在CABG术中应用可增加动脉桥血管血流量,同时不产生左心室负性肌力作用。

Effects of diltiazem on left ventricular function in patients undergoing coronary artery bypass graft during cardiopulmonary bypass

Objective To investigate the effects of low-dose diltiazem on antiarterial spasm and negative inotropic effects of left ventricular systolic function in patients undergoing coronary artery bypass grafting(CABG)under cardiopulmonary bypass.Methods Forty-three patients undergoing selective CABG under cardiopulmonary bypass(CPB),27 males and 16 females,aged 45-79 years,BMI 18-30 kg/m²,ASA physical statusⅡorⅢ,NYHA classⅡorⅢ,and with left ventricular ejection fraction(LVEF)≥45%,were randomly divided into diltiazem group(group D)and control group(group C).Both groups were given total intravenous anesthesia.After the transesophageal echocardiography(TEE)probe was inserted,patients in group D received continuous intravenous infusion of diltiazem 0.5μg·kg^-1·min^-1,and those in group C received saline until the end of the operation.Two-dimensional ultrasonic images were collected by TEE when the probe had been inserted(T₀),30 minutes after the probe inserted(T₁),20 minutes after CPB weaned(T₂),and 50 minutes after CPB weaned(T₃),the left ventricular function indicators such as the global longitudinal strain(GLS),the global circumferential strain(GCS),the standard deviation of global time-to-peak longitudinal strain(GLTSD)and the standard deviation of global time-to-peak circumferential strain(GCTSD)were recorded and computed at 4 time points by STI,and so did the traditional cardiac indicators including CI and LVEF.The flow of left internal mammary artery(LIMA)and the incidence of postoperative atrial fibrillation(POAF),the time of ventilator support,the length of stay in ICU,and the length of total stay in hospital were recorded.Results The GLS,GCS,GLTSD,and GCTSD,which indicated the function of left ventricle in different time points,showed no significant differences between the groups.CI and LVEF showed no significant differences between the two groups.The flow of LIMA in group D was higher than that of group C(P<0.05),cTnI tested 6 hours after operation was lower in group D than that in group C(P<0.05).There were no significant differences in the incidence of POAF,the time of ventilator support,the length of stay in ICU,and the length of total stay in hospital.Conclusion Low-dose intraoperative diltiazem infusion increases the blood flow of artrial grafts and shows no negative inotropic effects on left ventricular systolic function.