地尔硫在非体外循环下冠状动脉搭桥术围术期的心肌保护作用

Cardioprotective effects of diltiazem infusion in patients undergoing off-pump coronary artery bypass grafting

目的探讨非体外循环下冠状动脉搭桥术(OPCABG)围术期输注地尔硫对心肌的保护作用。方法40例择期手术患者,随机分为地尔硫组(D组)与硝酸甘油组(C组),每组20例。D组静脉给予地尔硫0.1mg·kg-1·h-1至术后24h,C组常规给予硝酸甘油0.1μg·kg-1·h-1至术后24h。分别在术毕、术后1、3、6、12和24h记录血流动力学参数,并采集血样测定血清肌钙蛋白I(cTnI)。结果与C组比较,D组的心率术后1、3、6、12、24h均较慢(P<0.05)。C组房颤4例,D组1例;C组室上性心动过速5例,D组1例。术后6h的cTnI,D组显著低于C组(P<0.05)。结论OPCABG围术期持续输注地尔硫有比硝酸甘油更好的抗缺血和抗心律失常的保护作用。

Objective To evaluate the cardioprotetive effects of diltiazem infusion in patients undergoing off-pump coronary artery bypass grafting （OPCABG）. Methods A double blind, randomised study was performed on 40 OPCABG patients. Infusion of diltiazem 0. 1 mg·kg^-1· h ^-1 or nitroglycerin 0. 1 μg· kg^-1· h ^-1 was given for 24 h in group D or C, respectively. MAP, HR,ECG and cardiac troponin I（cTnI） were monitored perioperatively. Results HR was kept stable during diltiazem infusion. The values of cTnI in group D were significantly lower than those of group C （P〈 0. 05）. The postoperative incidence of atrial fibrillation was significantly lower in group D（1/20）than that in group C（4/20）. conclusion Dihiazem infusion provides superior anti-ischemic protection and control of supraventricular arrhythmias as compared to nitroglycerin.