艾司洛尔作为持续逆行血液停搏液期间心肌保护剂的疗效。

Efficacy of esmolol as a myocardial protective agent during continuous retrograde blood cardioplegia.

作者信息

Scorsin Marcio, Mebazaa Alexandre, Al Attar Nawwar, Medini Betta, Callebert Jacques, Raffoul Richard, Ramadan Ramzi, Maillet Jean Michel, Ruffenach Alain, Simoneau François, Nataf Patrick, Payen Didier, Lessana Arrigo

机构信息

Service de Chirurgie Cardiaque, Centre Cardiologique du Nord, Saint-Denis, France.

出版信息

J Thorac Cardiovasc Surg. 2003 May;125(5):1022-9. doi: 10.1067/mtc.2003.175.

DOI:10.1067/mtc.2003.175

PMID:12771874

Abstract

OBJECTIVE

Esmolol, an ultra-short-acting beta-blocker, is known to attenuate myocardial ischemia-reperfusion injury. The aim of this study was to compare the effects of esmolol and potassium on myocardial metabolism during continuous normothermic retrograde blood cardioplegia.

METHODS

Forty-one patients operated on for isolated aortic valve stenosis were randomly assigned to continuous coronary infusion with either potassium or esmolol during cardiopulmonary bypass. Myocardial metabolism was assessed by measuring the transmyocardial gradient of oxygen content indexed to left ventricular mass of glucose, lactate, and nitric oxide. To do so, blood samples were simultaneously withdrawn upstream (in the cardioplegia line) and downstream of the myocardium (in the left coronary ostium) 10 and 30 minutes after aortic crossclamping.

RESULTS

Although the cardioplegia flow rate and pressure were similar, esmolol markedly reduced the transmyocardial gradient of oxygen content indexed to left ventricular mass compared with potassium: 13 +/- 6 vs 20 +/- 6 mL of oxygen per liter of blood per 100 g of myocardium, respectively, at 10 minutes and 16 +/- 8 vs 24 +/- 8 mL of oxygen per liter of blood per 100 g of myocardium, respectively, at 30 minutes (P =.009). Coronary glucose and lactate transmyocardial gradients were similar in both groups, indicating adequate myocardial perfusion in all patients at all times. In addition, during retrograde cardioplegia, esmolol showed a lower nitric oxide release compared with that caused by potassium (39 +/- 49 micro mol x L(-1) for potassium vs 14 +/- 8 micro mol x L(-1) for esmolol at 10 minutes and 39 +/- 47 micro mol x L(-1) for potassium vs 6 +/- 8 micro mol x L(-1) for esmolol at 30 minutes, P =.05). However, hemodynamic parameters and plasma troponin I levels remained unchanged postoperatively between the 2 types of cardioplegia.

CONCLUSION

Esmolol provides potent myocardial protection in hypertrophied hearts, at least in part, by reducing myocardial oxygen metabolism.

摘要

目的

艾司洛尔是一种超短效β受体阻滞剂，已知其可减轻心肌缺血再灌注损伤。本研究旨在比较艾司洛尔和钾在持续常温逆行血液心脏停搏期间对心肌代谢的影响。

方法

41例因单纯主动脉瓣狭窄接受手术的患者在体外循环期间被随机分配接受钾或艾司洛尔持续冠状动脉灌注。通过测量以左心室质量为指数的葡萄糖、乳酸和一氧化氮的心肌氧含量跨心肌梯度来评估心肌代谢。为此，在主动脉阻断10分钟和30分钟后，同时从心肌上游（在心脏停搏液管路中）和下游（在左冠状动脉口）采集血样。

结果

尽管心脏停搏液流速和压力相似，但与钾相比，艾司洛尔显著降低了以左心室质量为指数的心肌氧含量跨心肌梯度：10分钟时分别为每100克心肌每升血液13±6毫升氧和20±6毫升氧，30分钟时分别为每100克心肌每升血液16±8毫升氧和24±8毫升氧（P = 0.009）。两组冠状动脉葡萄糖和乳酸跨心肌梯度相似，表明所有患者在所有时间心肌灌注充足。此外，在逆行心脏停搏期间，与钾相比，艾司洛尔显示出较低的一氧化氮释放（钾在10分钟时为39±49微摩尔×升⁻¹，艾司洛尔为14±8微摩尔×升⁻¹；钾在30分钟时为39±47微摩尔×升⁻¹，艾司洛尔为6±8微摩尔×升⁻¹，P = 0.05）。然而，两种类型的心脏停搏术后血流动力学参数和血浆肌钙蛋白I水平保持不变。