冠状动脉旁路移植术应用盐酸地尔硫卓的临床分析

Application of Herbesser in OPCAB-A Randomized Perspective Clinical Trial

目的:评价盐酸地尔硫卓注射液在非体外循环冠状动脉旁路移植术(OPCAB)中的临床应用价值。方法:选择2007年4月—2008年3月接受OPCAB手术的51例冠心病患者,随机分为试验组(n=26)和对照组(n=25),试验组在围术期联合应用和单硝酸异山梨醇酯,对照组单纯应用单硝酸异山梨醇酯。观察并比较两组患者术后血清CKMb、cTnT、心率、PR间期、QRS时限、QT间期、血压、血常规、血生化等指标。结果:两组患者均无手术死亡,无并发症发生,心律失常的发生率及血流动力学无差别。术后24h和48h试验组血清CKMb和cTnT水平较对照组明显降低(P<0.05),术后72h后两组无统计学差异。试验组术后72h心率、收缩压和舒张压均稍低于对照组,但无统计学差异。试验组心肌氧耗指标(率压积)较对照组明显降低(P<0.05)。试验组PR间期和QT间期稍长于对照组,但无显著统计学差异。结论:在OPCAB围术期联合应用合贝爽注射液与单硝酸异山梨醇酯无明显不良反应,并能显著降低心肌氧耗,提供更佳的心肌保护。

Objective：To evaluate the clinical effect of diltiaxzem （Herbesser） infusion in OPCAB. Methods：51 Patients with coronary heart disease who underwent OPCAB during Apr. 2007 and Mar. 2008 were randomly divided into 2 groups： test group （n = 26） and control group （n = 25）. During the peri opertative period, Herbesser and Isosorbide Mononitrate was given in the control group. Serum CKMb, eTnT, heart rate PR-interval, ORS wave, QT interval, blood pressure, blood routine test and blood biochemistry marker were tested after operation and compared. Results： Of the 51 patients, no one died, or had postoperation complications. No differences of the incidence of arrhythmia, or hemodynamics were observed. Serum CKMb and cT- nT concentrations were significantly lower at both 24hrs and 48 hrs after operation in the test group （P〈0.05）, but not those at 72 hrs post-operatively. There was a slight and insignificant decrease of heart rate, systolic and dilatic blood pressure in the patients from the test group at 72 hrs post-operatively （P〈0.05）. PR interval and QT interval were slightly longer in the test group, but no statistical significance was attained. Conclusion：Joint use of Herbesser with Isosorbide Mononitrate during peri- operation period of OPCAB showed no serious side effect, but reduced myocardial oxygen consumption markdly, thus provided better myocardial protection.