Suttner S, Boldt J, Mengistu A, Lang K, Mayer J
Department of Anaesthesiology and Intensive Care Medicine, Klinikum Ludwigshafen, Bremserstr. 79, D-67063 Ludwigshafen, Germany.
Br J Anaesth. 2009 May;102(5):597-607. doi: 10.1093/bja/aep062. Epub 2009 Mar 31.
We sought to assess the intra- and postoperative haemodynamic effects of continuous perioperative beta-adrenergic blockade combined with phosphodiesterase (PDE) III inhibition and its potential benefits in limiting perioperative myocardial ischaemia in high-risk vascular surgery patients.
Seventy-five patients were randomly assigned to receive tight heart rate (HR) control by a continuous infusion of: esmolol in combination with the PDE III inhibitor enoximone (esmolol+enoximone group), esmolol infusion alone (esmolol group), or standard therapy (control group) for a period of 48 h. Myocardial ischaemia and dysfunction were detected by serial plasma Troponin T (TnT) and B-type natriuretic peptide (BNP) measurements.
Cardiac index (CI) increased significantly only in esmolol+enoximone-treated patients [CI: from 2.4 (0.2) litre min(-1) m(-2) at baseline to 3.2 (0.2) litre min(-1) m(-2) at 24 h after surgery; P=0.001] and was significantly higher than in the esmolol [CI: from 2.5 (0.2) litre min(-1) m(-2) at baseline to 2.6 (0.2) litre min(-1) m(-2) at 24 h; P=0.18] and the control groups [CI: from 2.4 (0.2) litre min(-1) m(-2) at baseline to 2.7 (0.2) litre min(-1) m(-2) at 24 h; P=0.13]. A significant postoperative release of TnT was detected only in control patients. Plasma BNP levels increased towards the end of surgery in all patients. Peak plasma BNP concentrations were significantly higher in control patients [293 (98) pg ml(-1)] than in esmolol [118 (71) pg ml(-1)] and in esmolol+enoximone-treated patients [78 (21) pg ml(-1)].
Inotropic therapy with the PDE III inhibitor enoximone combined with tight HR control by a continuous infusion of esmolol improved cardiac function and reduced myocardial ischaemia in high-risk vascular surgery patients. CLINICAL TRIAL REGISTRATION INFORMATION-URL: http://www.clinicaltrials.gov. Unique identifier: NCT00348101.
我们旨在评估围手术期持续β-肾上腺素能阻滞剂联合磷酸二酯酶（PDE）III抑制剂的术中和术后血流动力学效应，以及其在限制高危血管手术患者围手术期心肌缺血方面的潜在益处。
75例患者被随机分配接受以下治疗，持续输注48小时以严格控制心率（HR）：艾司洛尔联合PDE III抑制剂依诺昔酮（艾司洛尔+依诺昔酮组）、单独输注艾司洛尔（艾司洛尔组）或标准治疗（对照组）。通过连续检测血浆肌钙蛋白T（TnT）和B型利钠肽（BNP）来检测心肌缺血和功能障碍。
仅在接受艾司洛尔+依诺昔酮治疗的患者中，心脏指数（CI）显著增加[CI：从基线时的2.4（0.2）升·分钟-1·米-2增加至术后24小时的3.2（0.2）升·分钟-1·米-2；P=0.001]，且显著高于艾司洛尔组[CI：从基线时的2.5（0.2）升·分钟-1·米-2增加至24小时时的2.6（0.2）升·分钟-1·米-2；P=0.18]和对照组[CI：从基线时的2.4（0.2）升·分钟-1·米-2增加至24小时时的2.7（0.2）升·分钟-1·米-2；P=0.13]。仅在对照组患者中检测到术后TnT显著释放。所有患者在手术接近结束时血浆BNP水平均升高。对照组患者的血浆BNP峰值浓度[293（98）pg/ml]显著高于艾司洛尔组[118（71）pg/ml]和接受艾司洛尔+依诺昔酮治疗的患者[78（21）pg/ml]。
PDE III抑制剂依诺昔酮的正性肌力治疗联合持续输注艾司洛尔严格控制心率，可改善高危血管手术患者的心脏功能并减少心肌缺血。临床试验注册信息-网址：http://www.clinicaltrials.gov。唯一标识符：NCT00348101。
