Sher-i-Murtaza Muhammad, Zubair Muhammad, Jalal Anjum
CPE Institute of Cardiology, Multan, Pakistan.
J Pak Med Assoc. 2012 Dec;62(12):1271-6.
To evaluate the impact of preoperative oral trimetazidine on myocardial protection in coronary bypass surgery.
We conducted a prospective double blind randomized study in the Department of Cardiac Surgery, Chaudhry Pervaiz Elahi (CPE) Institute of Cardiology, Multan, Pakistan. One hundred and seventy (170) patients of isolated CABG were included in the study. All operations were done by conventional technique of CABG using cardiopulmonary bypass, moderate systemic hypothermia and cold antegrade blood cardioplegia. The patients were randomized into 2 groups i.e. Group 1 (n = 85), who received and Group 2 (n = 85), who did not receive Trimetazidine. Trimetazidine (20 mg) was given orally, at 10:00 pm the night before operation and also at 7.00 am on the day of surgery. The CPK and CK-MB levels were determined before operation, immediately after shifting to the ICU, 12 hours and 36 hours after the operation. The comparison of CPK and CK-MB levels was carried out using analysis of variance with repeated measures. The peri-operative clinical and laboratory data were compared using Student's t-test for numeric variables and Chi-square test for categoric varaibles. The difference was considered statistically significant if the p-value was < 0.05.
The pre-operative variables i.e. age, gender, Canadian Cardiovascular Society (CCS) class, ejection fraction, diabetes, history of smoking, haemoglobin level, serum creatinine etc had no differences in both group. Both groups showed no significant difference in Cardiopulmonary Bypass time (BPT), Aortic cross Clamp Time (CxT), prevalence of intra-operative arrhythmia and need for inotropic support. The analysis did not show any within group or between groups differences in the CPK and CKMB levels.
This study showed that oral Trimetazidine given before coronary bypass grafting did not provide any benefit in myocardial protection.
评估术前口服曲美他嗪对冠状动脉搭桥手术中心肌保护的影响。
我们在巴基斯坦木尔坦乔杜里·佩尔韦兹·埃拉希（CPE）心脏病学研究所心脏外科进行了一项前瞻性双盲随机研究。170例孤立性冠状动脉搭桥术患者纳入研究。所有手术均采用冠状动脉搭桥术的传统技术，使用体外循环、中度全身低温和冷顺行血液停搏液。患者被随机分为两组，即第1组（n = 85），接受曲美他嗪治疗；第2组（n = 85），未接受曲美他嗪治疗。曲美他嗪（20 mg）于手术前一晚10:00口服，手术当天上午7:00也口服一次。在手术前、转入重症监护病房后即刻、手术后12小时和36小时测定肌酸磷酸激酶（CPK）和肌酸激酶同工酶（CK-MB）水平。使用重复测量方差分析对CPK和CK-MB水平进行比较。采用学生t检验对数值变量的围手术期临床和实验室数据进行比较，采用卡方检验对分类变量进行比较。如果p值<0.05，则差异被认为具有统计学意义。
术前变量，即年龄、性别、加拿大心血管学会（CCS）分级、射血分数、糖尿病、吸烟史、血红蛋白水平、血清肌酐等，两组间无差异。两组在体外循环时间（BPT）、主动脉阻断时间（CxT）、术中心律失常发生率和使用血管活性药物支持方面均无显著差异。分析未显示CPK和CKMB水平在组内或组间有任何差异。
本研究表明，冠状动脉搭桥术前口服曲美他嗪在心肌保护方面未提供任何益处。
