Cardiac Surgical Research Unit, Alfred Hospital, Department of Surgery Monash University, Baker IDI Institute, Melbourne, Australia.
Heart Lung Circ. 2010 Oct;19(10):584-91. doi: 10.1016/j.hlc.2010.06.659. Epub 2010 Aug 2.
Perioperative therapy with antioxidants and metabolic substrates has the potential to reduce oxidative stress and improve recovery from cardiac surgery, particularly in elderly and high risk cases. The aim of this study was to assess the effect of perioperative metabolic therapy at a biochemical, clinical and economic level in cardiac surgical patients.
Patients (n=117, mean age 65 ± 1.0 years, 74% male) undergoing elective coronary artery bypass graft (CABG) and/or valve surgery in 2004-2006 were randomised to receive in double blinded fashion, while on the waiting list for surgery (approximately two months) and one month after surgery, either metabolic therapy (coenzyme Q(10), magnesium orotate, lipoic acid, omega-3 fatty acids and selenium) or placebo. Biochemical and clinical outcomes were assessed.
Cardiac surgery increased oxidative stress and decreased plasma levels of key antioxidants. Metabolic therapy for a mean of 76 ± 7.5 days increased antioxidant levels preoperatively so that the adverse effect of surgery on redox status was attenuated. Metabolic therapy reduced plasma troponin I, 24 hours postoperatively from 1.5 (1.2-1.8) (geometric mean 95% CI) μg/L, to 2.1 (1.8-2.6) μg/L (P=0.003) and shortened the mean length of postoperative hospital stay by 1.2 days from 8.1 (7.5-8.7) to 6.9 (6.4-7.4) days (P=0.004) and reduced hospital costs. Metabolic therapy was inexpensive and had no clinically significant side effects.
Perioperative metabolic therapy for cardiac surgery is safe and inexpensive and is associated with improved redox status, reduced myocardial damage, and shortened length of postoperative hospital stay.
围手术期抗氧化剂和代谢底物治疗有可能减轻氧化应激，促进心脏手术后的恢复，尤其是在老年和高危患者中。本研究旨在评估心脏外科患者围手术期代谢治疗在生化、临床和经济方面的效果。
2004-2006 年，117 例行择期冠状动脉旁路移植术（CABG）和/或瓣膜手术的患者（平均年龄 65±1.0 岁，74%为男性）被随机分配，在手术等待期（大约两个月）和手术后一个月内，分别接受代谢治疗（辅酶 Q10、肌醇、硫辛酸、ω-3 脂肪酸和硒）或安慰剂，双盲治疗。评估生化和临床结果。
心脏手术增加了氧化应激，降低了关键抗氧化剂的血浆水平。代谢治疗持续 76±7.5 天，术前增加了抗氧化剂水平，从而减轻了手术对氧化还原状态的不利影响。代谢治疗降低了术后 24 小时的血浆肌钙蛋白 I，从 1.5（1.2-1.8）（几何均数 95%可信区间）μg/L 降至 2.1（1.8-2.6）μg/L（P=0.003），并将术后平均住院时间缩短 1.2 天，从 8.1（7.5-8.7）天降至 6.9（6.4-7.4）天（P=0.004），并降低了住院费用。代谢治疗费用低廉，且无明显临床副作用。
心脏外科围手术期代谢治疗安全且费用低廉，与改善氧化还原状态、减少心肌损伤和缩短术后住院时间有关。
