Ozaydin Mehmet, Peker Tulay, Akcay Selahaddin, Uysal Bayram A, Yucel Habil, Icli Atilla, Erdogan Dogan, Varol Ercan, Dogan Abdullah, Okutan Huseyin
Clin Cardiol. 2014 Feb;37(2):108-14. doi: 10.1002/clc.22227.
Oxidative stress and inflammation during cardiac surgery may be associated with acute renal injury (ARI). N-acetyl cysteine (NAC) and carvedilol have antioxidant and anti-inflammatory properties.
A combination of carvedilol and NAC should decrease the incidence of ARI more than metoprolol or carvedilol.
Patients undergoing cardiac surgery were randomized to metoprolol, carvedilol, or carvedilol plus NAC. End points were occurrence of ARI and change in preoperative to postoperative peak creatinine levels.
ARI incidence was lower in the carvedilol plus NAC group compared with the metoprolol (21.0% vs 42.1%; P = 0.002) or carvedilol (21.0% vs 38.6%; P = 0.006) groups, but was similar between the metoprolol and carvedilol groups (P = 0.62). Preoperative and postoperative day 1 creatinine levels were similar among the metoprolol (1.02 [0.9-1.2] and 1.2 [0.92-1.45]) the carvedilol (1.0 [0.88-1.08] and 1.2 [0.9-1.5]) and the carvedilol plus NAC groups (1.06 [0.9-1.18] and 1.1 [1.0-1.21] mg/dL; all P values >0.05). Postoperative day 3, day 5, and peak creatinine levels were lower in the carvedilol plus NAC group (1.11 [1.0-1.23], 1.14 [1.0-1.25] and 1.15 [1.0-1.25]) as compared with the metoprolol (1.4 [1.3-1.49], 1.3 [1.0-1.54] and 1.3 [1.0-1.54]) or carvedilol groups (1.2 [1.0-1.52], 1.25 [1.0-1.52] and 1.25 [1.0-1.55] mg/dL; all P values <0.05), but were similar between the metoprolol and carvedilol groups (all P values >0.05).
Combined carvedilol and NAC decreased ARI incidence as compared with carvedilol or metoprolol. No difference was detected between carvedilol and metoprolol.
心脏手术期间的氧化应激和炎症可能与急性肾损伤（ARI）相关。N-乙酰半胱氨酸（NAC）和卡维地洛具有抗氧化和抗炎特性。
卡维地洛与NAC联合应用比美托洛尔或卡维地洛更能降低ARI的发生率。
接受心脏手术的患者被随机分为美托洛尔组、卡维地洛组或卡维地洛加NAC组。终点指标为ARI的发生情况以及术前至术后肌酐峰值水平的变化。
与美托洛尔组（21.0%对42.1%；P = 0.002）或卡维地洛组（21.0%对38.6%；P = 0.006）相比，卡维地洛加NAC组的ARI发生率更低，但美托洛尔组和卡维地洛组之间相似（P = 0.62）。美托洛尔组（1.02[0.9 - 1.2]和1.2[0.92 - 1.45]）、卡维地洛组（1.0[0.88 - 1.08]和1.2[0.9 - 1.5]）以及卡维地洛加NAC组（1.06[0.9 - 1.18]和1.1[1.0 - 1.21]mg/dL）术前及术后第1天的肌酐水平相似（所有P值>0.05）。与美托洛尔组（1.4[1.3 - 1.49]、1.3[1.0 - 1.54]和1.3[1.0 - 1.54]）或卡维地洛组（1.2[1.0 - 1.52]、1.25[1.0 - 1.52]和1.25[1.0 - 1.55]mg/dL）相比，卡维地洛加NAC组术后第3天、第5天及肌酐峰值水平更低（所有P值<0.05），但美托洛尔组和卡维地洛组之间相似（所有P值>0.05）。
与卡维地洛或美托洛尔相比，卡维地洛与NAC联合应用可降低ARI发生率。卡维地洛与美托洛尔之间未检测到差异。
