Department of Cardiothoracic and Vascular Surgery, Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India.
Eur J Cardiothorac Surg. 2010 Jul;38(1):86-90. doi: 10.1016/j.ejcts.2010.01.027. Epub 2010 Feb 25.
To assess the effects of preoperative administration of allopurinol in patients undergoing open-heart surgery (OHS) for valvular heart diseases.
In this prospective randomised double-blind study, 50 consecutive patients undergoing OHS for valvular heart disease were randomised into two groups of 25 patients each: (a) control group received placebo and (b) test group received allopurinol prior to surgery. Serum troponin T and creatine phosphokinase-MB (CPK-MB) isoenzymes were measured prior to the induction of anaesthesia, at the time of aortic cross-clamp release and 24h following termination of cardiopulmonary bypass. Postoperatively assessed parameters were inotropic score, rhythm, and duration of mechanical ventilation and occurrence of a low cardiac output state.
Significant differences were observed with respect to inotropic score: median 5 ((0-25) vs 0 (0-25) p=0.027) and mean 6.44+/-6.145 versus 3.4+/-5.54, mean duration of mechanical ventilation (11.1+/-4.9 vs 7.5+/-2.5 h, p=0.002, hospital stay (6.35+/-1.43 vs 5.04+/-0.611, p=0.001) and maintenance of normal sinus rhythm (NSR) (18 vs 25, p=0.004) between the control groups versus the test group, respectively. There were no significant differences in the levels and trends of troponin T and CPK-MB between the two groups.
The administration of allopurinol prior to OHS for valvular heart diseases is associated with increased conversion and maintenance to normal sinus rhythm, reduced inotropic score and a reduction in the duration of mechanical ventilation and hospital stay. There was, however, no significant difference in the blood levels of CPK-MB and troponin T and a large sample size is required to assess this further.
评估在接受心脏瓣膜手术（OHS）的患者中术前给予别嘌醇的效果。
在这项前瞻性随机双盲研究中，将 50 例连续接受 OHS 治疗的心脏瓣膜病患者随机分为两组，每组 25 例：（a）对照组给予安慰剂；（b）实验组在手术前给予别嘌醇。在麻醉诱导前、主动脉阻断释放时和体外循环结束后 24 小时测量血清肌钙蛋白 T 和肌酸磷酸激酶同工酶（CPK-MB）同工酶。术后评估的参数包括正性肌力评分、节律、机械通气时间和发生低心输出量状态的情况。
在正性肌力评分方面观察到显著差异：中位数分别为 5（0-25）比 0（0-25）（p=0.027）和平均值分别为 6.44+/-6.145 比 3.4+/-5.54，平均机械通气时间（11.1+/-4.9 比 7.5+/-2.5 小时，p=0.002）、住院时间（6.35+/-1.43 比 5.04+/-0.611，p=0.001）和窦性心律维持率（18 比 25，p=0.004）在对照组与实验组之间分别存在差异。两组之间肌钙蛋白 T 和 CPK-MB 的水平和趋势均无显著差异。
在心脏瓣膜病 OHS 前给予别嘌醇与窦性心律转复和维持率增加、正性肌力评分降低以及机械通气时间和住院时间缩短有关。然而，CPK-MB 和肌钙蛋白 T 的血液水平没有显著差异，需要更大的样本量来进一步评估。
