200例冠状动脉搭桥手术中的β受体阻滞剂应用

Beta-blockade in 200 coronary bypass grafting procedures.

作者信息

Kuhn-Régnier F, Geissler H J, Marohl S, Mehlhorn U, De Vivie E R

机构信息

Department of Cardiothoracic Surgery University of Cologne; Cologne, Germany.

出版信息

Thorac Cardiovasc Surg. 2002 Jun;50(3):164-7. doi: 10.1055/s-2002-32414.

DOI:10.1055/s-2002-32414

PMID:12077690

Abstract

BACKGROUND

Continuous perfusion of the coronary arteries with high-dose beta-blocker (esmolol)-enriched blood has been shown to represent an alternative for myocardial protection during coronary bypass grafting (CABG). Here, we will report on our experience in 200 unselected consecutive cases where this technique was used.

METHODS

Eighty percent of the patients (age: 63.3 +/- 0.6 years, ejection fraction: 60 +/- 1.2 %, emergency cases: 11 %) had 3-vessel disease, 34 % had a history of myocardial infarction within less than 90 days preoperatively. The Euro score amounted to 6 +/- 0.3. During 52 +/- 1.2 min of aortic cross-clamp time on normothermic cardiopulmonary bypass, 2.9 +/- 0.1 distal anastomoses were performed on a slow hypocontractile beating heart induced by continuous infusion of 788 +/- 20 mg esmolol per operation. All data: mean +/- SEM.

RESULTS

Postoperatively, patients were ventilated for 25 +/- 5.1 hours and stayed on ICU for 2.3 +/- 0.3 days. The postoperative myocardial infarction rate was 4%. Patients left the hospital after 11.2 +/- 0.4 days. Thirty-day mortality was 2.5 %, and 3-month mortality was 3 %.

CONCLUSIONS

High-dose beta-blockade is a safe and effective technique in CABG procedures. It may be especially advantageous in high-risk patients.

摘要

背景

已证明在冠状动脉搭桥术（CABG）期间，用富含高剂量β受体阻滞剂（艾司洛尔）的血液持续灌注冠状动脉是一种心肌保护的替代方法。在此，我们将报告在200例连续非选择性病例中使用该技术的经验。

方法

80%的患者（年龄：63.3±0.6岁，射血分数：60±1.2%，急诊病例：11%）患有三支血管病变，34%的患者术前不到90天有心肌梗死病史。欧洲心脏手术风险评估系统（Euro score）评分为6±0.3。在常温体外循环下主动脉阻断52±1.2分钟期间，每次手术通过持续输注788±20毫克艾司洛尔诱导心脏缓慢收缩减弱跳动时，进行了2.9±0.1次远端吻合。所有数据：均值±标准误。