艾司洛尔对常温不停跳心内直视手术期间心肌损伤标志物的影响

Effect of esmolol on the early cardiac injury markers during direct version intracardiac beating heart surgery

目的 探讨艾司洛尔对常温不停跳心内直视手术期间心肌损伤标志物的影响。方法选择48例择期二尖瓣置换术病人随机分为对照组(C组)和艾司洛尔组(E组),每组各24例,常规建立心肺转流(CPB),平行循环后不降温及不主动复温,阻断腔静脉,不阻断主动脉,平均动脉压(MAP)维持在50～70mmHg,在心脏跳动下进行手术。E组在心内直视手术开始前予艾司洛尔1～2mg/kg静脉注射后,以0.3％的浓度静滴维持心率在30～50次/分。分别于手术前、术后即刻、术后6小时、12小时、24小时、48小时取动脉血测定血清C—反应蛋白(CRP)、肌酸激酶同工酶(CK—MB)、肌钙蛋白T(cTnT)和肌钙蛋白I(cTnI)浓度变化。结果 两组病人性别、年龄、心功能、心胸比值(C/T)差异无显著意义;术前两组间CRP、CK—MB、cTnT、cTnI差异无显著意义(P>0.05),两组患者血清CRP、CK—MB、cTnT、cTnI浓度在CPB后即刻显著升高(P<0.01),E组于术后6小时达峰值,术后24小时降至正常水平,C组于术后12小时达峰值,术后48小时降至正常值,同一时点比较,E组明显低于C组(P<0.05 or 0.01)。结论 艾司洛尔用于常温不停跳心内直视手术中可显著降低心肌损伤标志物升高程度,使酶峰提前,促进术后心功能恢复,具有良好的心肌保护作用。

Objective To investigate the cardiac protective effect of esmolol and its effect on early cardiac injury markers during direct version intracardiac beating heart surgery. Methods 48 patients undergoing elective direct version intracardiac surgery (mitral valve replacement, MVR) were divided into two groups randomly. Control group (n = 24): Normothermia cardio-pulmonary bypass (CPB) direct version intracardiac beating heart surgery: Esmolol group (n=24): Normothermia CPB direct version intracardiac beating heart surgery, esmolol was intravenously dripped during CPB to maintain the heart rate at 30-50 beat per minute (bpm). The Changes of Creaction protein (CRP), creation kinase MB isoform (CK-MB), cardiac troponin T (cTnT) and cardiac troponin I (cTnI) were detected at different time. Electrocardiogram (ECG), hemodynamic parameters and clinical results were recorded simultaneously. Results The operation was accomplished in all patients and hemodynamic parameters were steadily maintained in both groups. The baseline serum concentration of CRP, CK-MB, cT-nl and cTnT were normal before operation, and increase immediately after the surgery (P<0. 01), reached the peak after 12 hours and recovered to normal level after 48 hours in control group. The serum concentrations of CRP, CK-MB, cTnI and cTnT reached the peak value at 6 hours post-operation and recovered to normal level at 24 hours in esmolol group. The serum concentrations of CRP, CK-MB, cTnI and cTnT in esmolol group were significantly lower than those in control group at the same time (P<0. 05 or 0. 01). Conclusion The early cardiac injury markers were elevated during direct version intracardiac beating heart surgery and the application of esmolol could significantly decrease the release of those markers, hence and protect myocardium.