远程缺血后处理预处理对非体外循环冠状动脉旁路移植术患者的影响——随机对照试验。

Effects of remote ischemic preconditioning with postconditioning in patients undergoing off-pump coronary artery bypass surgery--randomized controlled trial.

机构信息

Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University Hospital, Seoul, Korea.

出版信息

Circ J. 2012;76(4):884-90. doi: 10.1253/circj.cj-11-1068. Epub 2012 Feb 3.

DOI:10.1253/circj.cj-11-1068

PMID:22301846

Abstract

BACKGROUND

Myocardial injury is associated with an adverse outcome after off-pump coronary artery bypass graft surgery (OPCAB). The authors conducted a randomized controlled trial to evaluate whether remote ischemic preconditioning (RIPC) with remote ischemic postconditioning (RIPostC) reduces myocardial injury in patients undergoing OPCAB.

METHODS AND RESULTS

Seventy patients scheduled for OPCAB were randomly assigned to an RIPC+RIPostC group (n=35) or a control group (n=35). In the RIPC+RIPostC group, 4 cycles of 5-min ischemia and 5-min reperfusion were done on a lower limb before anastomoses (RIPC) and after anastomoses (RIPostC). RIPC+RIPostC significantly reduced postoperative serum troponin I levels (P=0.001). The area under the curve for postoperative troponin I was 48.7% lower in the RIPC+RIPostC group (median [interquartile range], 21.3 h·ng⁻¹·ml⁻¹, 16.5-53.1 h·ng⁻¹·ml⁻¹ vs. 41.5 h·ng⁻¹·ml⁻¹, 24.6-90.2 h·ng⁻¹·ml⁻¹, P=0.020). There was no significant difference in creatinine levels and PaO₂/F(i)O₂ ratios between the 2 groups.

CONCLUSIONS

RIPC+RIPostC by lower limb ischemia decreased postoperative myocardial enzyme elevation by almost half postoperatively in patients undergoing OPCAB.

摘要

背景

非体外循环冠状动脉旁路移植术（OPCAB）后心肌损伤与不良预后相关。作者进行了一项随机对照试验，以评估远程缺血预处理（RIPC）联合远程缺血后处理（RIPostC）是否能减少 OPCAB 患者的心肌损伤。

方法和结果

70 例行 OPCAB 的患者被随机分为 RIPC+RIPostC 组（n=35）或对照组（n=35）。在 RIPC+RIPostC 组，在吻合前（RIPC）和吻合后（RIPostC）下肢进行 4 个周期的 5 分钟缺血和 5 分钟再灌注。RIPC+RIPostC 显著降低术后血清肌钙蛋白 I 水平（P=0.001）。RIPC+RIPostC 组术后肌钙蛋白 I 曲线下面积降低 48.7%（中位数[四分位距]，21.3 h·ng⁻¹·ml⁻¹，16.5-53.1 h·ng⁻¹·ml⁻¹ vs. 41.5 h·ng⁻¹·ml⁻¹，24.6-90.2 h·ng⁻¹·ml⁻¹，P=0.020）。两组间肌酐水平和 PaO₂/F(i)O₂ 比值无显著差异。