Sirlak Mustafa, Akar A Ruchan, Eryilmaz Sadik, Cetinkanat Elif Kuzgun, Ozcinar Evren, Kaya Bulent, Elhan Atilla Halil, Ozyurda Umit
Department of Cardiovascular Surgery, Ankara University School of Medicine, Dikimevi-Ankara 06340, Turkey.
Tex Heart Inst J. 2010;37(2):172-7.
The aim of the present study was to determine whether oral pretreatment with micronized purified flavonoid fraction (Daflon) has beneficial effects on cardiac function and outcome after cardiac operations. This prospective, randomized trial enrolled 43 patients who had an impaired preoperative left ventricular ejection fraction of less than 0.50 (mean, 0.45 +/- 0.04) and a mean New York Heart Association functional class status of 2.30 +/- 0.74; all were scheduled for elective coronary artery bypass grafting. Patients who were randomized to the Daflon group (n=21) received oral Daflon 500 mg (6 tablets daily for 4 days, followed by 2 tablets for 3 days) preoperatively. Outcome variables included perioperative hemodynamic data, inotropic requirements, morbidity, and death, as well as cardiac ischemia and various outcome markers. Hemodynamic and biochemical data were collected before induction of anesthesia, perioperatively before starting cardiopulmonary bypass, immediately after bypass, and at the 24th postoperative hour. There was only 1 death (in the Daflon group). During the post-cardiopulmonary bypass period, troponin I and lactate dehydrogenase levels were significantly lower in the Daflon group. Also, the New York Heart Association status of the patients in the Daflon group was significantly lower postoperatively. Differences between the 2 groups in lengths of stay in the intensive care unit and hospital, inotropic requirements, and left ventricular ejection fraction levels did not reach statistical significance. Orally administered Daflon might provide better outcomes for patients who have impaired cardiac function before undergoing cardiac operations that require cardiopulmonary bypass.
本研究的目的是确定术前口服微粒化纯化黄酮类化合物组分(达弗隆)是否对心脏手术后的心脏功能和预后有有益影响。这项前瞻性随机试验纳入了43例术前左心室射血分数低于0.50(平均为0.45±0.04)且纽约心脏协会心功能分级平均为2.30±0.74的患者;所有患者均计划接受择期冠状动脉搭桥术。随机分配到达弗隆组(n = 21)的患者在术前口服达弗隆500 mg(每日6片,共4天,随后3天每日2片)。观察指标包括围手术期血流动力学数据、血管活性药物需求、发病率和死亡率,以及心脏缺血和各种预后标志物。在麻醉诱导前、围手术期体外循环开始前、体外循环结束后即刻以及术后24小时收集血流动力学和生化数据。仅1例死亡(在达弗隆组)。在体外循环后期间,达弗隆组的肌钙蛋白I和乳酸脱氢酶水平显著较低。此外,达弗隆组患者术后纽约心脏协会心功能分级显著降低。两组在重症监护病房和医院的住院时间、血管活性药物需求以及左心室射血分数水平方面的差异未达到统计学意义。对于在需要体外循环的心脏手术前心脏功能受损的患者,口服达弗隆可能会带来更好的预后。