艾司洛尔在国人心脏瓣膜置换术中的心肌保护作用

The protective effect of esmolol on the myocardium during cardiac valve replacement in Chinese patients

目的 研究小剂量艾司洛尔在国人心脏瓣膜置换术中的心肌保护作用。方法 2 4例心脏瓣膜置换术病人随机分为艾司洛尔组 (E组 )和对照组 (C组 ) ,每组 12例。E组于肝素化时静脉输注艾司洛尔 2mg/kg ,继以 2 0 0 μg·kg-1·min-1输注直至开放主动脉后 10分钟。C组输入同容量的复方氯化钠液。观察病人心脏复跳方式和时间、心律失常变化、多巴胺和硝普钠的用量之比 (DA/SNP)、肝素化前和停CPB后 30分钟中心静脉血氧饱和度 (ScvO2 )以及 2 4小时内肌酸磷酸激酶同工酶 (CK MB)的活性变化。结果 两组心脏复跳方式和时间无明显差异。复跳后E组病人心律失常明显少于C组 (P <0 0 5 ) ,ScvO2 高于C组 (P <0 0 5 ) ,DA/SNP低于C组 (P <0 0 1) ,开放主动脉后1、6小时CK MB的活性明显低于C组 (P <0 0 5 ,P <0 0 1)。

Objective To Investigate the protective effect of low dose esmolol on the myocardium during cardiac valve replacement in Chinese patients.Methods Twenty four patients scheduled for cardiac valve replacement were devided equally into two groups at random.In the esmolol group(group E),an esmolol infusion was given at a loading dose of 500μg·kg -1·min -1 over 4min at the time of heparinization,followed by a continuous infusion of 200μg·kg -1·min -1 until 10min after aortic declamping.In the control group(group C),a placebo(Ringers solution)infusion was given instead.The incidence of spontaneous heart-beat restore,arrhythmia,the ratio of dopamine and sodium nitroprusside doses(DA/SNP) and central venous oxygen saturation(ScvO 2) before heparinization and at 30min after the end of cardiopulmonary bypass(CPB) of each group were recorded.Arterial blood samples were taken at the time of before operation (T 0),1(T 1),6(T 2) and 24(T 3)h after aortic declamping for determination of the activity of serum creatine kinase isoenzyme(CK-MB).Results The incidence of arrythmia and the ratio of DA/SNP were higher in group C than those in group E.ScvO 2 at 30min after the end of CPB was lower in group C than that in group E.The activity of serum CK-MB at T 1 and T 2 in group E was lower than that in group C.Conclusion Low dose esmolol exerts some cardioprotective effect during cardiac valve replacement in Chinese patients.