地尔硫卓在非体外循环下冠状动脉旁路移植术中的应用

Application of diltiazem in off-pump coronary artery bypass grafting

目的评价地尔硫卓在非体外循环冠状动脉旁路移植术（OPCABG）中的临床效果。方法接受OPCABG的40例冠心病患者,随机均分为两组,麻醉诱导后分别泵注地尔硫卓1~3μg.kg-1.min-1（A组）或硝酸甘油0.5~2.0μg.kg-1.min-1（B组）。记录诱导前、用药30 min、移植血管远端吻合中、出手术室前4个时点的血流动力学指标;术后24、48 h采血测量血清肌酸激酶同工酶（CK-MB）和肌钙蛋白T（cTnT）。结果与B组比较,A组术中血流动力学较为稳定（P〈0.05）;A组术后24 h和48 h血清CK-MB[（24.32±42.75）U/L vs.（39.37±35.50）U/L和（21.50±14.12）U/L vs.（35.40±46.59）U/L]和cTnT[（0.17±0.23）ng/ml vs.（0.32±0.28）ng/ml和（0.20±0.25）ng/ml vs.（0.37±0.48）ng/ml]水平均明显低于B组（P〈0.05）。结论在OPCABG手术期间使用地尔硫卓能显著降低心肌氧耗,提供较好的心肌保护,无明显不良反应。

Objective To evaluate the clinical efficacy of diltiaxzem infusion in patients undergoing off-pump coronary artery bypass grafting（OPCABG）.Methods Fourty patients with coronary heart disease undergoing OPCABG were randomly divided into 2 groups of A and B with 20 cases each.After anesthesia induction,the patients in group A were infused diltiaxzem 1～3 μg·kg-1·min-1 and those in group B were infused nitroglycerin 0.5～2.0 μg·kg-1·min-1.Hemodynamics was recorded during operation and serum levels of creatine kinase-MB（CK-MB） isozyme and calcitonin-T（cTnT） were measured at 24 h and 48 h after surgery.Results Compared to group B,the hemodynamics was more stable in group A （P0.05）.Serum CK-MB was lower in group A than that in group B at 24 h [（24.32±42.75） U/L vs.（39.37±35.50） U/L] and 48 h [（21.50±14.12） U/L vs.（35.40±46.59） U/L] after surgery（P0.05）.So did the serum cTnT[（0.17±0.23） ng/ml vs.（0.32±0.28） ng/ml at 24 h and （0.20±0.25） ng/ml vs.（0.37±0.48） ng/ml at 48 h ]（P0.05）.Conclusion During OPCABG,diltiazem can reduce myocardial oxygen consumption and protect myocardium without remarkable adverse effects.