左西孟旦在非体外循环下冠状动脉旁路移植术围术期中的心肌保护作用

Myocardial Protective Effect of Levosimendan during Off-Pump Coronary Artery Bypass Grafting During Perioperaive Period

目的 探讨左西孟旦在非体外循环下冠状动脉旁路移植术(OPCABG)围术期中的心肌保护作用。方法 选择2017年8月至2018年8月于新乡市第一人民医院行OPCABG治疗的患者46例,根据治疗方法分为试验组及对照组,各23例。对照组患者在围术期采用常规药物治疗,以单硝酸异山梨酯注射液扩张冠状动脉、以低分子肝素钙注射液抗凝、以酒石酸美托洛尔片控制基础心率等;试验组在对照组的基础上予以左西孟旦治疗,术前24h内起始1h以10μg/kg静脉泵入,后23h以0.1μg/(kg·min)静脉泵入。取切皮前(T1)、桥血管通畅后即刻(T2)、术后4h(T3)、术后12h(T4)、术后24h(T5)比较两组患者心肌肌钙蛋白I(cTnI)、肌酸激酶同工酶(CK-MB)和超氧化物歧化酶(SOD);术后1周复查心脏彩色多普勒超声心动图并对比左心室舒张末期内径、左心室射血分数。结果 对照组cTnI、CK-MB在T1~T5呈上升趋势,试验组cTnI、CK-MB在T1~T4上升,T5降低,且对照组上升速度更快(P<0.05),两组SOD在T1~T3降低,对照组下降速度更快(P<0.05),T4~T5上升,试验组上升速度更快(P<0.05)。两组在组间、时点间、组间·时点间交互作用比较差异均有统计学意义(P<0.05)。术后1周,两组左心室舒张末期内径均降低,左心室射血分数均升高,试验组左心室舒张末期内径低于对照组[(46.4±4.7)mm比(49.7±3.8)mm],左心室射血分数高于对照组[(51.4±4.7)%比(48.7±3.2)%],两组左心室舒张末期内径在组间、组间·时点间交互作用比较差异无统计学意义(P>0.05),在时点间比较差异有统计学意义(P<0.05),两组左心室射血分数在组间比较差异无统计学意义(P>0.05),在时点间、组间·时点间交互作用比较差异有统计学意义(P<0.05)。结论 左西孟旦在OPCABG的围术期应用,通过减低cTnI、CK-MB的上升幅度、促进SOD的回弹,从而保护心肌发挥心肌保护作用。

Objective To investigate the myocardial protective effect of levosimendan in off-pump coronary artery bypass grafting(OPCABG) during perioperative period. Methods A total of 46 patients with OPCABG in Xinxiang First People′s Hospital were included in the study.The patients were divided into a trial group and a control group according to their treatment,with23 cases in each group.The control group was treated with conventional drugs during perioperative period (such as coronary artery dilatation with isosorbide mononitrate injection,anticoagulation with low molecular weight heparins calcium injection,control of baseline heart rate with metoprolol tartrate tablets,etc.).The trial group was treated with levosimendan on the basis of the control group′s regimen.Levosimendan was given to the tiral group within24 hours before operation:at24 hours before operation,initial intravenous infusion of10 μg/kg for1hour;later,intravenous infusion of 0.1 μg/(kg·min) for23 hours.At the time of before skin incision(T1),immediately after vascular patency(T 2), 4 hours after operation(T 3),12 hours after operation(T 4),and24 hours after operation(T 5),the cardiac troponin I(cTnI),creatine kinase isoenzyme(CK-MB) and superoxide dismutase(SOD) in the two groups were compared;color Doppler echocar diography was done one week after operation to compared the left ventricular end- diastolic diameter reduction and left ventricular ejection fraction. Results In the control group,cTnI and CK-MB increased from T1to T 5,the levels of cTnI and CK-MB increased from T1to T 4 and decreased to T 5 in the trial group,and the rising speed of the control group was faster ( P < 0.05).SOD decreased from T1to T 3 and increased from T 4 to T 5 in both groups,but the decline rate of the control group was faster( P <0.05), while the increase rate of the trial group was faster( P <0.05).There were significant diffe- rences in groups,time points and group·time point interaction( P <0.05).After one week of the operation,the left ventri- cular end-diastolic diameter decrease and left ventricular ejection fraction increase in both groups,and left ventricular end- dias tolic diameter of trial group was higher than that of the control group[(46.4±4.7) mm vs (49.7±3.8) mm],left ventricular ejection fraction increase of trial group was lower than that of the control group[(51.4±4.7)% vs (48.7± 3.2 )%].There was no significant difference in left ventricular end- diastolic diameter between the two groups and intergroups-time points interaction( P >0.05),and there was significant difference between time points( P <0.05).There was no significant difference in left ventricular ejection fraction between the two groups( P >0.05),and there was significant diffe- rence between time points and intergroups-time points interaction( P <0.05). Conclusion The application of levosimendan in the perioperative period of OPCABG can reduce the increase of cTnI and CK-MB,promote the rebound of SOD,which protected myocardium.