Möllhoff T, Schmidt C, Van Aken H, Berendes E, Buerkle H, Marmann P, Reinbold T, Prenger-Berninghoff R, Tjan T D T, Scheld H H, Deng M C
Universitätsklinikum Münster, Klinik and Poliklinik für Anästhesiologie und operative Intensivmedizin, Germany.
Eur J Anaesthesiol. 2002 Nov;19(11):796-802. doi: 10.1017/s026502150200128x.
Myocardial ischaemia and infarction are major complications immediately after coronary artery bypass grafting. They may be due to incomplete surgical revascularization, perioperative anaesthetic management or vasospasm of arterial grafts, e.g. the internal mammary artery. Infusions of nifedipine or milrinone have been advocated to prevent spasm of the mammary artery. The study compared the incidence of myocardial ischaemia after continuous infusion of either nifedipine (0.2 microg kg(-1) min(-1)) or milrinone (0.375 microg kg(-1) min(-1)) in patients with compromised left ventricular function scheduled for elective coronary artery bypass graft.
After Institutional Review Board approval, this double-blinded randomized clinical study enrolled 30 adult patients with compromised left ventricular function (ejection fraction < 0.4) scheduled for elective coronary artery bypass grafting after written informed consent had been obtained. Ischaemia was detected by Holter electrocardiographic monitoring. The incidence of myocardial cell death was monitored by serial determinations of the creatine kinase-MB (CK-MB) and troponin-I.
New ST elevation > or = 0.2 mV or new ST depression < or = 0.1 mV occurred in five of 15 patients in the milrinone group (33.3%) and in 13 of 15 patients (86.6%) in the nifedipine group (P < 0.05). There were increases in CK-MB and troponin-I in both groups. Twenty-four hours postoperatively, CK-MB (P = 0.003) and troponin-I (P = 0.001) were significantly higher in the nifedipine group.
Perioperative continuous infusion of milrinone, compared with nifedipine, results in a significantly lower incidence of myocardial ischaemia and myocardial cell damage after elective coronary artery bypass grafting.
心肌缺血和梗死是冠状动脉旁路移植术后即刻出现的主要并发症。其可能归因于手术血运重建不完全、围手术期麻醉管理或动脉移植物（如乳内动脉）的血管痉挛。有人主张输注硝苯地平或米力农以预防乳内动脉痉挛。本研究比较了择期冠状动脉旁路移植且左心室功能受损患者持续输注硝苯地平（0.2微克/千克/分钟）或米力农（0.375微克/千克/分钟）后心肌缺血的发生率。
经机构审查委员会批准，这项双盲随机临床研究纳入了30例左心室功能受损（射血分数<0.4）的成年患者，这些患者在获得书面知情同意后计划进行择期冠状动脉旁路移植术。通过动态心电图监测检测缺血情况。通过连续测定肌酸激酶同工酶（CK-MB）和肌钙蛋白I来监测心肌细胞死亡的发生率。
米力农组15例患者中有5例（33.3%）出现新的ST段抬高≥0.2毫伏或新的ST段压低≤0.1毫伏，硝苯地平组15例患者中有13例（86.6%）出现（P<0.05）。两组的CK-MB和肌钙蛋白I均升高。术后24小时，硝苯地平组的CK-MB（P = 0.003）和肌钙蛋白I（P = 0.001）显著更高。
与硝苯地平相比，择期冠状动脉旁路移植术后围手术期持续输注米力农导致心肌缺血和心肌细胞损伤的发生率显著更低。
