低温缺血期间艾司洛尔心脏停搏液的疗效。

Efficacy of esmolol cardioplegia during hypothermic ischaemia.

机构信息

Department of Cardiac Surgical Research/Cardiothoracic Surgery, Guy's and St Thomas' NHS Foundation Trust, The Rayne Institute (King's College London), St Thomas' Hospital, London, UK.

出版信息

Eur J Cardiothorac Surg. 2018 Feb 1;53(2):392-399. doi: 10.1093/ejcts/ezx311.

DOI:10.1093/ejcts/ezx311

PMID:28958063

Abstract

OBJECTIVES

Cardioplegic arrest using a polarizing solution has been shown to have beneficial advantages for cardioprotection compared with depolarizing (potassium-based) arrest; most studies, however, have looked at normothermic ischaemia with short infusion intervals (every 10-15 min). This study examines the protective efficacy of an esmolol-based cardioplegia during hypothermic arrest, together with a prolonged infusion interval (30 min) for increased clinical feasibility.

METHODS

Isolated Langendorff-perfused hearts were subjected to arrest with St Thomas' Hospital cardioplegia (STH2), or esmolol cardioplegia (single- or multidose infusion at 32°C) for 60-min, 90-min or 120-min global ischaemia at 32°C, and recovery of function (left ventricular developed pressure) measured. A further study examined the protective efficacy of multidose esmolol cardioplegia compared with hypothermia alone at temperatures of 20°C, 28°C and 32°C compared with 37°C for 120 min of ischaemia.

RESULTS

Esmolol cardioplegic arrest with multidose infusion at 32°C significantly improved recovery of function (left ventricular developed pressure) compared with 32°C STH2, at each ischaemic duration (88 ± 3 vs 66 ± 3% at 60 min, 82 ± 3 vs 51 ± 3% at 90 min and 73 ± 6 vs 49 ± 4% at 120 min; P < 0.05). At various hypothermic temperatures, esmolol cardioplegia significantly improved protection compared with hypothermia alone (88 ± 4%, 88 ± 3% and 72 ± 3% vs 60 ± 3%, 30 ± 2% and 15 ± 1% at 20°C, 28°C and 32°C, respectively; P < 0.05); however, at 37°C, there was no difference in protection. Contracture during ischaemia mirrored the effects of left ventricular developed pressure recovery.

CONCLUSIONS

Esmolol cardioplegia (a polarizing solution), used as a multidose infusion during hypothermia, significantly improved cardioprotection compared with the depolarizing STH2. An increased infusion interval of 30 min indicates improved clinical feasibility.

摘要

目的

与去极化（基于钾的）停搏相比，使用极化溶液进行心脏停搏已显示出对心脏保护的有益优势；然而，大多数研究都着眼于使用较短的输注间隔（每 10-15 分钟）的常温缺血。本研究在低温停搏期间检查了依托咪酯心脏停搏液的保护效果，并延长了输注间隔（30 分钟），以提高临床可行性。

方法

离体 Langendorff 灌注心脏采用 Thomas 医院心脏停搏液（STH2）或依托咪酯心脏停搏液（32°C 时单次或多次输注）进行 60 分钟、90 分钟或 120 分钟的 32°C 整体缺血，测量功能恢复（左心室发展压）。进一步的研究比较了在 20°C、28°C 和 32°C 下与 37°C 相比，低温时使用依托咪酯心脏停搏液与单纯低温的保护效果。120 分钟缺血。

结果

32°C 时依托咪酯心脏停搏液多次输注可显著改善功能恢复（左心室发展压）与 32°C STH2 相比，在每个缺血持续时间内（60 分钟时 88 ± 3%对 66 ± 3%，90 分钟时 82 ± 3%对 51 ± 3%，120 分钟时 73 ± 6%对 49 ± 4%；P<0.05）。在不同的低温下，与单纯低温相比，依托咪酯心脏停搏液可显著提高保护作用（20°C 时 88 ± 4%、88 ± 3%和 72 ± 3%对 60 ± 3%、30 ± 2%和 15 ± 1%，28°C 和 32°C 分别；P<0.05）；然而，在 37°C 时，保护作用没有差异。缺血期间的收缩反映了左心室发展压恢复的效果。