Casthely Pierre Abdon, Defilippi Vincent, Pakonis Gregory, Bikkina Mahesh, Yoganathan Thil, Komer Claudia, Cornwell Lorraine
Department of Anesthesiology, Seton Hall University, St. Joseph's Regional Medical Center, Paterson, NJ, USA.
J Cardiothorac Vasc Anesth. 2008 Apr;22(2):192-8. doi: 10.1053/j.jvca.2007.11.002.
To evaluate whether intracoronary nicardipine can provide myocardial protection in patients undergoing off-pump coronary artery bypass graft surgery.
Clinical trial.
Single-institution, academic hospital.
Off-pump coronary artery bypass patients with good ejection fraction.
Patients were divided into 2 equal groups: group A received 1 mL (0.1 mg) of intracoronary nicardipine before performing the distal anastomosis, and group B patients received 1 mL of NaCl in the coronary artery. Transesophageal echocardiography (PowerVision 6000, 9-mm 6-MHz probe; Toshiba, Elmsford, NY) was used in this study.
Left ventricular ejection fraction, cardiac index, tissue Doppler imaging, velocity of the left ventricle and mitral annulus, and troponin levels were measured in both groups. The incidence of diastolic dysfunction as evaluated by superior pulmonary blood flow and pulsed-wave Doppler of the mitral annulus was significantly lower in group A. Tissue Doppler imaging velocity of the left ventricle and mitral annular displacement were significantly higher in the nicardipine group. Group A patients had significantly lower incidences of ST-segment changes, prolonged pharmacologic support in the postoperative period, and lower levels of troponin after surgery.
Intracoronary nicardipine improves ventricular function in patients undergoing off-pump coronary artery bypass surgery.
评估冠状动脉内注射尼卡地平能否为非体外循环冠状动脉搭桥手术患者提供心肌保护。
临床试验。
单机构学术医院。
射血分数良好的非体外循环冠状动脉搭桥患者。
患者被分为两组，每组人数相等：A组在进行远端吻合术前接受1毫升（0.1毫克）冠状动脉内尼卡地平注射，B组患者在冠状动脉内接受1毫升氯化钠注射。本研究使用经食管超声心动图（PowerVision 6000，9毫米6兆赫探头；东芝，纽约州埃尔姆斯福德）。
两组均测量左心室射血分数、心脏指数、组织多普勒成像、左心室和二尖瓣环速度以及肌钙蛋白水平。通过肺上血流和二尖瓣环脉冲波多普勒评估的舒张功能障碍发生率在A组显著更低。尼卡地平组左心室组织多普勒成像速度和二尖瓣环位移显著更高。A组患者术后ST段改变发生率、术后延长的药物支持时间以及术后肌钙蛋白水平显著更低。
冠状动脉内注射尼卡地平可改善非体外循环冠状动脉搭桥手术患者的心室功能。
