Boldt Joachim, Brosch Christian, Suttner Stefan, Piper Sven N, Lehmann Andreas, Werling Christiane
Department of Anesthesiology and Intensive Care Medicine, Klinikum der Stadt Ludwigshafen, Bremserstrasse 79, 67063 Ludwigshafen, Germany.
Intensive Care Med. 2002 Oct;28(10):1462-9. doi: 10.1007/s00134-002-1435-y. Epub 2002 Aug 27.
Elderly patients appear prone to develop overwhelming post-bypass inflammation and organ dysfunction. We assessed the effect of prophylactic administration of the phosphodiesterase III inhibitor enoximone on inflammation and organ function.
Prospective, blinded, randomized, placebo-controlled study.
Clinical investigations on a surgical intensive care unit.
40 consecutive patients aged over 80 years undergoing first-time coronary artery bypass grafting.
Enoximone was given to 20 patients after induction of anesthesia (initial bolus 0.5 mg/kg) followed by a continuous infusion of 2.5 micro g/kg per minute until the 2nd postoperative day. Control patients ( n=20) received saline solution.
Interleukins 6, 8, and 10 and soluble adhesion molecules were measured. Liver function was assessed by the monoethylglycine-xylidide test and by measuring alpha-glutathione S-transferase plasma levels; splanchnic perfusion by continuous gastric tonometry; renal function by measuring creatinine and alpha(1)-microglobulin. Interleukins increased significantly more in controls than in the enoximone-pretreated patients. Soluble adhesion molecules were significantly more increased in controls. Liver function was more altered in controls than in the enoximone-pretreated patients. alpha(1)-Microglobulin increased significantly more in controls than in the enoximone group, indicating less tubular damage in the verum group.
. Prophylactic use of enoximone in cardiac surgery patients aged over 80 years resulted in less post-bypass inflammation and improvement in markers of organ function than in the placebo group. The exact mechanisms by which enoximone exerts its beneficial effects in these patients remains to be elucidated.
老年患者似乎易于发生搭桥术后严重炎症和器官功能障碍。我们评估了预防性给予磷酸二酯酶III抑制剂依诺昔酮对炎症和器官功能的影响。
前瞻性、盲法、随机、安慰剂对照研究。
外科重症监护病房的临床研究。
40例连续的80岁以上首次接受冠状动脉搭桥术的患者。
20例患者在麻醉诱导后给予依诺昔酮（初始推注剂量为0.5 mg/kg），随后以每分钟2.5μg/kg的速度持续输注直至术后第2天。对照组患者（n = 20）接受生理盐水。
检测白细胞介素6、8和10以及可溶性黏附分子。通过单乙基甘氨酸-对二甲苯酰胺试验和测量α-谷胱甘肽S-转移酶血浆水平评估肝功能；通过连续胃张力测定评估内脏灌注；通过测量肌酐和α1-微球蛋白评估肾功能。对照组白细胞介素的增加明显多于依诺昔酮预处理组患者。对照组可溶性黏附分子的增加明显更多。对照组肝功能的改变比依诺昔酮预处理组患者更明显。对照组α1-微球蛋白的增加明显多于依诺昔酮组，表明试验组肾小管损伤较轻。
80岁以上心脏手术患者预防性使用依诺昔酮比安慰剂组术后炎症反应更轻，器官功能标志物有所改善。依诺昔酮在这些患者中发挥有益作用的确切机制尚待阐明。
