Noyez L, Knape J T, Arnold B J, Vermeulen P M, van der Werf T, Gimbrère J, Lacquet L K, Flameng W
Department of Cardiac Surgery, University Hospital St. Radboud, Nijmegen, The Netherlands.
Eur J Cardiothorac Surg. 1992;6(7):377-81. doi: 10.1016/1010-7940(92)90176-x.
The concept of pretreatment of the myocardium with a pharmacological agent protecting the cell against ischemic and reperfusion injury is very attractive. Lidoflazine, a calcium overload blocker, predominantly membrane stabilizing, is able to prevent cell damage during ischemic arrest and reperfusion. The purpose of this study was to determine whether the combination of lidoflazine pretreatment and St. Thomas' Hospital cardioplegia can provide, in clinical practice, better myocardial protection in aorto-coronary bypass grafting than St. Thomas' Hospital cardioplegia alone. As indices for myocardial protection, recovery of cardiac function, enzyme release, and clinical outcome were registered. Ninety-three patients undergoing aorto-coronary bypass surgery were studied. These patients were randomized into two groups in a double blind fashion. Patients in group A (n = 48) received lidoflazine 1 mg/kg intravenously over a period of 20 min before initiation of cardiopulmonary bypass. Group B (n = 45) receiving placebo, acted as a control group. Myocardial protection consisted of intermittent infusion of cold 4 degrees C St. Thomas' Hospital cardioplegia, topical slush ice, and systemic hypothermia (28 degrees C rectal). No significant differences between the two groups were noted in terms of recovery of cardiac function, enzyme release, incidence of myocardial infarction, low cardiac output, rhythm, and conduction disturbances. In conclusion, our data suggest that the combination of intravenous pretreatment with lidoflazine and St. Thomas' Hospital cardioplegia did not provide significant additional myocardial protection in the clinical situation.
使用一种可保护细胞免受缺血及再灌注损伤的药物对心肌进行预处理的概念非常具有吸引力。利多氟嗪是一种钙超载阻滞剂，主要起膜稳定作用，能够预防缺血性停搏和再灌注期间的细胞损伤。本研究的目的是确定在临床实践中，利多氟嗪预处理与圣托马斯医院心脏停搏液联合使用，在主动脉冠状动脉搭桥术中是否能比单独使用圣托马斯医院心脏停搏液提供更好的心肌保护。记录心脏功能恢复、酶释放和临床结局作为心肌保护的指标。对93例行主动脉冠状动脉搭桥手术的患者进行了研究。这些患者以双盲方式随机分为两组。A组（n = 48）患者在体外循环开始前20分钟内静脉注射1 mg/kg利多氟嗪。B组（n = 45）接受安慰剂，作为对照组。心肌保护措施包括间歇性输注4℃冷的圣托马斯医院心脏停搏液、局部冰泥和全身低温（直肠温度28℃）。两组在心脏功能恢复、酶释放、心肌梗死发生率、低心排血量、心律和传导障碍方面均未观察到显著差异。总之，我们的数据表明，在临床情况下，静脉注射利多氟嗪预处理与圣托马斯医院心脏停搏液联合使用并不能提供显著的额外心肌保护。
