Fujiwara Hidenori, Sakurai Masahiro, Namai Asako, Kawamura Takae
Department of Cardiovascular Surgery, National Hospital Organization Sendai Medical Center, 2-8-8 Miyagino, Miyagino-ku, Sendai 983-8520, Japan.
Gen Thorac Cardiovasc Surg. 2009 Mar;57(3):132-7. doi: 10.1007/s11748-008-0341-9. Epub 2009 Mar 12.
Postoperative atrial fibrillation is the most common complication after coronary artery bypass grafting (CABG). This complication is associated with prolongation of the intensive care unit stay and hospitalization time with attendant increased hospitalization costs, and it is an important risk factor for perioperative cerebrovascular accidents. Landiolol is a newly developed ultrashort-acting beta-adrenoceptor antagonist with a half-life of 3 min that is eight times more cardioselective than esmolol. The purpose of this study was to investigate the prophylactic effect of continuous administration of low-dose landiolol on postoperative atrial fibrillation.
We reviewed all patients who underwent CABG alone at our hospital from April 2002 and September 2006. Patients with a previous history of atrial arrhythmias were excluded. The remaining patients were divided to two groups: landiolol group (n = 20), and control group (n = 35). Administration of landiolol started after cardiopulmonary bypass with a loading dose of 1.5-2.5 mug.kg(t-1).min(-1) and continued for the first 2 days after surgery. The incidence of postoperative atrial fibrillation was noted. Continuous variables were compared between groups by means of Student's t-test. Categorical variables were compared by means of the chi(2) test or Fisher's exact test.
The occurrence of atrial fibrillation after CABG in the control group was statistically more than in the landiolol group (P = 0.04). There were no statistical differences between the groups regarding the cardiac index or the dose of inotropic agents during the perioperative period.
Intraoperative and perioperative administration of low-dose landiolol has a preventive effect on the appearance of atrial fibrillation after CABG surgery.
术后心房颤动是冠状动脉旁路移植术（CABG）后最常见的并发症。该并发症与重症监护病房停留时间和住院时间延长相关，随之而来的是住院费用增加，并且它是围手术期脑血管意外的重要危险因素。兰地洛尔是一种新开发的超短效β肾上腺素能受体拮抗剂，半衰期为3分钟，心脏选择性比艾司洛尔高8倍。本研究的目的是探讨持续给予低剂量兰地洛尔对术后心房颤动的预防作用。
我们回顾了2002年4月至2006年9月在我院单独接受CABG的所有患者。排除有房性心律失常既往史的患者。其余患者分为两组：兰地洛尔组（n = 20）和对照组（n = 35）。体外循环后开始给予兰地洛尔，负荷剂量为1.5 - 2.5μg·kg⁻¹·min⁻¹，并在术后的头2天持续给药。记录术后心房颤动的发生率。连续变量采用Student's t检验在组间进行比较。分类变量采用χ²检验或Fisher精确检验进行比较。
对照组CABG后心房颤动的发生率在统计学上高于兰地洛尔组（P = 0.04）。两组在围手术期的心脏指数或强心剂剂量方面无统计学差异。
术中及围手术期给予低剂量兰地洛尔对CABG术后心房颤动的出现有预防作用。
