对于择期非体外循环冠状动脉旁路移植术（CABG）的慢性阻塞性肺疾病（COPD）患者，用N-乙酰半胱氨酸替代茶碱：在心血管外科病房可行吗？

N-acetylcysteine instead of theophylline in patients with COPD who are candidates for elective off-pump CABG surgery: Is it possible in cardiovascular surgery unit?

作者信息

Mirhosseini Seyed Jalil, Forouzannia Seyed Khalil, Nasirian Marjan, Ali-Hassan-Sayegh Sadegh

机构信息

Department of Cardiac Surgery, Yazd Cardiovascular Researches Center, Afshar Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.

出版信息

Saudi J Anaesth. 2013 Apr;7(2):151-4. doi: 10.4103/1658-354X.114069.

DOI:10.4103/1658-354X.114069

PMID:23956714

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3737690/

Abstract

BACKGROUND

Forced expiratory volume in one second (FEV1) is a good predictor of chronic obstructive pulmonary disease (COPD). COPD is characterized by a chronic limitation of airflow. This study was designed to compare the effects and complications of theophylline alone, N-acetylcysteine (NAC) alone, and a combination of the two drugs on the rates of FEV1 in patients with COPD who were candidates for off-pump coronary artery bypass graft (CABG) surgery.

METHODS

This clinical trial was performed on 100 patients who had a smoking history of 27 pack years with a range of 20 to 40 pack years but were not heavy smokers and were candidates for elective off-pump CABG surgery in Afshar Cardiovascular Hospital, Yazd, Iran. The patients with a history of asthma and bronchospasm and non-COPD respiratory disorders were excluded. There were three groups, that is, the theophylline group (n=33) that received theophylline 10 mg/kg TDS after consumption of food, NAC group (n=33) who received NAC 10-15 mg/kg BD after consumption of food, and the combined group (n=32) who received theophylline and NAC together. Data were analyzed by analysis of variance (ANOVA), Chi-square, and exact test for quantitative and qualitative variables.

RESULTS

One hundred patients with COPD enrolled in this study as possible candidates for CABG surgery. Average age of the patients was 60.36±10.21 years. Of the participants, 83 (83.3%) were male and 17 (17%) were female. Rate of postoperative FEV1 to basal FEV1 was 0.76±0.32, 0.66±0.22, and 0.69±0.24 in the treatments with theophylline, NAC, and the combination, respectively. Theophylline, NAC, and a combination of these drugs can decrease the rate of postoperative FEV1 compared to basal FEV1 significantly. (P=0.0001).

CONCLUSION

Theophylline alone, NAC alone, and a combination of these drugs improve pulmonary function, and there are no significant differences between these protocols. Stomach discomfort and cardiac complications in treatment with theophylline alone is significantly higher than NAC alone and the combination.

摘要

背景

一秒用力呼气容积（FEV1）是慢性阻塞性肺疾病（COPD）的良好预测指标。COPD的特征是气流长期受限。本研究旨在比较单独使用茶碱、单独使用N-乙酰半胱氨酸（NAC）以及两种药物联合使用对择期非体外循环冠状动脉旁路移植术（CABG）的COPD患者FEV1率的影响及并发症。

方法

本临床试验对100例有吸烟史（吸烟量为20至40包年，平均27包年）但非重度吸烟者且符合伊朗亚兹德阿夫沙尔心血管医院择期非体外循环CABG手术条件的患者进行。排除有哮喘、支气管痉挛病史及非COPD呼吸系统疾病的患者。分为三组，即茶碱组（n = 33），于进食后接受10mg/kg茶碱，每日三次；NAC组（n = 33），于进食后接受10 - 15mg/kg NAC，每日两次；联合组（n = 32），同时接受茶碱和NAC。对定量和定性变量的数据采用方差分析（ANOVA）、卡方检验和确切概率法进行分析。

结果

100例COPD患者纳入本研究作为CABG手术的可能候选者。患者平均年龄为60.36±10.21岁。参与者中，83例（83.3%）为男性，17例（17%）为女性。茶碱、NAC及联合用药治疗后，术后FEV1与基础FEV1的比率分别为0.76±0.32、0.66±0.22和0.69±0.24。与基础FEV1相比，茶碱、NAC及两者联合用药均能显著降低术后FEV1率（P = 0.0001）。