Mirhosseini Seyed Jalil, Forouzannia Seyed Khalil, Sayegh Ali Hassan, Sanatkar Mehdi
Department of Cardiovascular Surgery, Afshar Hospital, Shahid Sadoughi University of medical sciences, Yazd, Iran.
Acta Med Iran. 2011;49(5):288-92.
Atrial fibrillation (AF) is the most common arrhythmia after cardiothoracic surgery. AF following coronary artery bypass graft (CABG) is associated with an increase in morbidity, mortality, hemodynamic instability, thromboembolic events, severity of heart failure and ICU and hospital stay. Corticosteroids have a variety of beneficial effects on recovery after elective surgery. This study was designed to test the hypothesis that low dose of Methylprednisolone (MP) can affect post-CABG AF and early complications in patients with severe left ventricle dysfunction who underwent elective off-pump coronary artery bypass. A total of 120 patients with LV dysfunction undergoing elective off- pump CABG randomly received either MP or placebo. Diabetic patients and those who were receiving corticosteroids were excluded. The MP group received 5mg/kg of MP intravenously after induction of anesthesia and the placebo group received an equal volume of normal saline. We evaluated Post-CABG variables including incidence, duration and frequency of AF recurrence and early morbidity such as bleeding, infection, vomiting, renal and respiratory dysfunctions, ICU or hospital stay and early mortality. The mean age of patients was 62.11 ± 12.34 years with the 2.4 male to female ratio. AF occurred in 23(19.2%) patients. No significant difference in the incidence of new AF was found between the placebo (21.7%) and MP group (16.7%) (P=0.47). MP did not affect postoperative bleeding, infection, vomiting, renal and respiratory dysfunction and mortality; however, MP significantly reduced ICU and hospital length of stay. MP did not affect the incidence, duration and frequency of AF recurrence in patients with severe LV dysfunction undergoing off-pump CABG. However, MP could reduce ICU and hospital stay significantly in these patients.
心房颤动（AF）是心胸外科手术后最常见的心律失常。冠状动脉旁路移植术（CABG）后发生的AF与发病率、死亡率、血流动力学不稳定、血栓栓塞事件、心力衰竭严重程度以及重症监护病房（ICU）住院时间和住院时间的增加有关。皮质类固醇对择期手术后的恢复有多种有益作用。本研究旨在检验以下假设：低剂量甲泼尼龙（MP）可影响择期非体外循环冠状动脉旁路移植术的严重左心室功能障碍患者CABG术后的AF及早期并发症。共有120例左心室功能障碍患者接受择期非体外循环CABG，随机接受MP或安慰剂治疗。排除糖尿病患者和正在接受皮质类固醇治疗的患者。MP组在麻醉诱导后静脉注射5mg/kg的MP，安慰剂组接受等量的生理盐水。我们评估了CABG术后的变量，包括AF复发的发生率、持续时间和频率以及早期发病率，如出血、感染、呕吐、肾和呼吸功能障碍、ICU或住院时间以及早期死亡率。患者的平均年龄为62.11±12.34岁，男女比例为2.4:1。23例（19.2%）患者发生AF。安慰剂组（21.7%）和MP组（16.7%）之间新发AF的发生率无显著差异（P=0.47）。MP不影响术后出血、感染、呕吐、肾和呼吸功能障碍及死亡率；然而，MP显著缩短了ICU和住院时间。MP不影响接受非体外循环CABG的严重左心室功能障碍患者AF复发的发生率、持续时间和频率。然而，MP可显著缩短这些患者的ICU和住院时间。
