曲美他嗪在非体外循环下冠状动脉旁路移植术中的心肌保护作用

The cardioprotective effects of trimetazidine during off-pump coronary artery bypass grafting

目的:探讨曲美他嗪(trimetazidine,TMZ)在非体外循环冠状动脉旁路移植术(off-pump coronary artery bypass grafting,OPCABG)中的心肌保护作用及相关机制。方法:将72例冠心病患者随机分为治疗组和对照组,各36例。治疗组除接受常规手术前药物治疗外,手术前l周加用TMZ 20 mg,3次/d,直至手术当日清晨顿服TMZ 60 mg。对照组则只接受常规药物治疗。所有研究数据均经统计学方法处理。结果:治疗组术后4 h及24 h的cTnI及BNP均比对照组显著降低(P<0.05),术后4 h的心指数明显高于对照组(P<0.05)。术后48 h的多巴胺累积用量治疗组明显少于对照组(P<0.05)。术后24 h测定的心指数及术后4 h、24 h二次测定的肺毛细血管楔压(PCWP)在两组之间差异无统计学意义(P>0.05)。结论:对OPCABG患者,TMZ能够减少缺血再灌注损伤,明显提高术后的心排血量,降低手术并发症,改善生活质量。

Objective： To investigate the cardioprotective efficacy of trimetazidine （TMZ）and the related mechanism during off-pump coronary artery bypass grafting（OPCABG）. Methods： 72 pa- tients with coronary artery disease were randomly divided into treated group（36 cases）and control group（36 cases）. The treated group was given TMZ 20 mg three times a day in one week before operation and 60 mg in the morning of operation day, except for conventional medical therapy. The control group was only given conventional medical therapy. All data were statistically analyzed. Results ： The treated group had lower levels of cTnI and BNP 4 and 24 hours after operation, high- er CI 4 hours after operation and litter dosage of dopamine within 48 hours than control group （ P 〈 0.05）. The differences of CI 24 hours after operation and PCWP 4 and 24 hours after operation were not statistically significant. Conclusion： TMZ may reduce ischemia-reperfusion damage during OPCABG, improve the cardiac output after operation, lower the incidence of post-operative complications, improve the quality of life.