Goto Koji, Shingu Chihiro, Miyamoto Shinji, Miyakawa Hiroshi, Noguchi Takayuki
Department of Anesthesiology, Faculty of Medicine, Oita University, Oita, Japan.
J Clin Anesth. 2007 Nov;19(7):523-9. doi: 10.1016/j.jclinane.2007.05.003.
To examine the effect of landiolol (normal dose) on hemodynamics and left ventricular (LV) function.
Prospective, observational, repeated-measures study.
University hospital.
56 adult patients who were diagnosed with angina pectoris and who underwent elective off-pump coronary artery bypass surgery.
Patients were divided into two groups based on a preoperative LV ejection fraction (EF) 50% or higher (normal EF group, n = 28) and lower than 50% (low EF group, n = 28). Hemodynamics and LV function were recorded using a pulmonary artery catheter and transesophageal echocardiography at three time points (before administration of landiolol, immediately before completion of administration, and 15 minutes after completion of administration).
Individual hemodynamic data were obtained using a pulmonary artery catheter, and individual parameters were determined from LV short-axis views in transesophageal echocardiography.
Mean preoperative EFs were 57% +/- 5% and 47% +/- 3% in the normal and low EF groups, respectively. In both groups, landiolol produced a significant decrease in heart rate (HR), which then returned to baseline 15 minutes after completion of administration. A significant decrease in mean arterial pressure occurred in the low EF group, but the decrease was within 30% of baseline. In the normal EF group, there was no decrease in cardiac index, but a significant increase in stroke index, in addition to an increase in stroke volume. In the low EF group, cardiac index significantly decreased along with the decrease in HR, but there was no increase in end-diastolic volume or stroke volume.
Administration of landiolol using the presently recommended dosage and administration route causes a decrease in HR without aggravation of hemodynamics in patients with normal cardiac function, but in patients with preoperative EF lower than 50%, it may lead to further deterioration of cardiac function due to a decrease in HR.
探讨兰地洛尔（常规剂量）对血流动力学和左心室（LV）功能的影响。
前瞻性、观察性、重复测量研究。
大学医院。
56例被诊断为心绞痛并接受择期非体外循环冠状动脉搭桥手术的成年患者。
根据术前左心室射血分数（EF）将患者分为两组，EF≥50%（正常EF组，n = 28）和EF＜50%（低EF组，n = 28）。在三个时间点（兰地洛尔给药前、给药即将结束时、给药结束后15分钟）使用肺动脉导管和经食管超声心动图记录血流动力学和左心室功能。
使用肺动脉导管获取个体血流动力学数据，并通过经食管超声心动图的左心室短轴视图确定个体参数。
正常EF组和低EF组术前平均EF分别为57%±5%和47%±3%。两组中，兰地洛尔均使心率（HR）显著降低，给药结束后15分钟心率恢复至基线水平。低EF组平均动脉压显著降低，但降低幅度在基线的30%以内。正常EF组心脏指数无下降，但每搏指数显著增加，同时每搏量增加。低EF组中，心脏指数随HR降低而显著下降，但舒张末期容积和每搏量均未增加。
按照目前推荐的剂量和给药途径使用兰地洛尔，在心脏功能正常的患者中可降低HR且不加重血流动力学异常，但在术前EF低于50%的患者中，可能因HR降低导致心功能进一步恶化。
