Zhou Rong-Hua, Yu Hui, Yin Xiao-Rong, Li Qi, Yu Hong, Yu Hai, Chen Chan, Xiong Ji-Yue, Qin Zhen, Luo Ming, Tan Zhao-Xia, Liu Ting
Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu, People's Republic of China.
Department of Cardiovascular Surgery, West China Hospital of Sichuan University, Chengdu, People's Republic of China.
Heart. 2017 Jul;103(14):1122-1127. doi: 10.1136/heartjnl-2016-310758. Epub 2017 Feb 28.
This study was conducted to determine whether the administration of intralipid just before aortic cross-unclamping would reduce myocardial injury in patients undergoing valve replacement surgery.
Seventy-three adult patients, scheduled for elective aortic or mitral valve surgery without significant coronary stenosis (>70%), were randomly assigned to the intralipid postconditioning (ILPC) group (n=37) or control group (n=36): the ILPC group received an intravenous infusion of 20% intralipid (2 mL/kg) just 10 min before aortic cross-unclamping, and the control group received an equivalent volume of normal saline. Serum cardiac troponin T (cTnT) and creatine kinase-MB (CK-MB) was measured before surgery and at 4, 12, 24, 48 and 72 hours after surgery. The primary end points were the 72-hour area under the curve (AUC) for cTnT and CK-MB.
No significant difference between the ILPC and control arm was observed, including the age, sex or number of aortic versus mitral valves or left ventricular ejection fraction at baseline. The total 72-hour AUC of cTnT and CK-MB in patients assigned to ILPC were significantly reduced by 32.3% (p=0.004) and 26.4% (p=0.0185) compared with control, respectively. None of the treated patients had abnormal blood lipid metabolism, abnormal renal or hepatic function or significant related complications.
The protective effect of postischaemic administration of intralipid prior to aortic cross-unclamping on reperfusion injury was found when determined by biomarkers of myocardial injury but not by cardiac function or other clinical outcomes in patients undergoing valve replacement surgery. Hence, clinical benefits of this protection need larger clinical trials to confirm.
ClinicalTrials.gov ID: ChiCTR-IOR-14005318.
本研究旨在确定在主动脉阻断钳夹前即刻给予脂肪乳剂是否能减少接受瓣膜置换手术患者的心肌损伤。
73例计划进行择期主动脉或二尖瓣手术且无明显冠状动脉狭窄（>70%）的成年患者，被随机分配至脂肪乳剂后处理（ILPC）组（n = 37）或对照组（n = 36）：ILPC组在主动脉阻断钳夹前10分钟静脉输注20%脂肪乳剂（2 mL/kg），对照组输注等量生理盐水。在手术前以及手术后4、12、24、48和72小时测量血清心肌肌钙蛋白T（cTnT）和肌酸激酶同工酶MB（CK-MB）。主要终点是cTnT和CK-MB的72小时曲线下面积（AUC）。
ILPC组和对照组在年龄、性别、主动脉瓣与二尖瓣的数量或基线左心室射血分数方面未观察到显著差异。与对照组相比，分配至ILPC组的患者cTnT和CK-MB的72小时总AUC分别显著降低了32.3%（p = 0.004）和26.4%（p = 0.0185）。所有接受治疗的患者均未出现血脂代谢异常、肾或肝功能异常或明显的相关并发症。
在接受瓣膜置换手术的患者中，通过心肌损伤生物标志物测定发现，主动脉阻断钳夹前给予脂肪乳剂进行缺血后处理对再灌注损伤具有保护作用，但在心脏功能或其他临床结局方面未观察到该作用。因此，这种保护作用的临床益处需要更大规模的临床试验来证实。
ClinicalTrials.gov标识符：ChiCTR-IOR-14005318。
