Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea.
Acta Anaesthesiol Scand. 2011 Apr;55(4):452-9. doi: 10.1111/j.1399-6576.2011.02407.x.
Pulmonary dysfunction related to inflammatory response and radical oxygen species remains a problem in off-pump coronary bypass graft surgery (OPCAB), especially in patients with reduced left ventricular (LV) function. The aim of this study was to evaluate the effect of N-acetylcysteine (NAC) on pulmonary function following OPCAB.
Patients with LV ejection fraction ≤40% were randomly assigned to receive either a bolus of 100 mg/kg of intravenous NAC over a 15-min period immediately after anesthetic induction, followed by an intravenous infusion at 40 mg/kg/day for 24 h (NAC group, n=24), or a placebo (control group, n=24). Hemodynamic and pulmonary parameters, and the incidence of acute lung injury (PaO(2)/FiO(2)<300 mmHg) were assessed and compared.
The pulmonary vascular resistance index (PVRI) did not change during mechanical heart displacement compared with the baseline value in the NAC group while it was significantly increased in the control group. Significantly less number of patients developed acute lung injury at 2 h after the surgery in the NAC group. The other pulmonary parameters and the duration of ventilator care were all similar.
NAC demonstrated promising results in terms of mitigating the increase in PVRI during mechanical heart displacement and attenuating the development of acute lung injury in the immediate post-operative period. However, NAC could not induce a definite improvement in the other important pulmonary variables including PaO(2)/FiO(2) and Q(s)/Q(t), and did not lead to a decreased duration of ventilatory care or length of stay in the intensive care unit.
与炎症反应和活性氧有关的肺功能障碍仍然是不停跳冠状动脉旁路移植术（OPCAB）中的一个问题，尤其是在左心室（LV）功能降低的患者中。本研究旨在评估 N-乙酰半胱氨酸（NAC）对 OPCAB 后肺功能的影响。
LV 射血分数≤40%的患者被随机分配接受 100 mg/kg 的静脉 NAC 推注，持续 15 分钟，然后在麻醉诱导后立即开始以 40 mg/kg/天的速度静脉输注 24 小时（NAC 组，n=24），或接受安慰剂（对照组，n=24）。评估并比较血流动力学和肺参数以及急性肺损伤（PaO(2)/FiO(2)<300 mmHg）的发生率。
与 NAC 组相比，在机械心脏移位期间，肺血管阻力指数（PVRI）与基线值相比没有变化，而在对照组中则明显增加。NAC 组在手术后 2 小时内发生急性肺损伤的患者数量明显减少。其他肺参数和呼吸机护理时间均相似。
NAC 在减轻机械心脏移位期间 PVRI 的增加以及减轻术后即刻急性肺损伤的发生方面显示出良好的效果。然而，NAC 不能确定改善其他重要的肺变量，包括 PaO(2)/FiO(2)和 Q(s)/Q(t)，也不能导致通气护理时间或重症监护病房住院时间的缩短。
