Department of Anaesthesiology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
Department of Anaesthesiology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.
Kardiol Pol. 2018;76(1):99-106. doi: 10.5603/KP.a2017.0183. Epub 2017 Oct 5.
Atrial fibrillation (AF) is one of the most frequently occurring dysrhythmias after coronary artery bypass graft (CABG) surgery.
The aim of this study was to evaluate the effect of intravenous N-acetylcysteine (NAC) on the prevention of AF after CABG surgery.
In a double-blind, randomised controlled trial, a total of 150 patients who were scheduled for on-pump CABG surgery were randomly assigned into two groups. In group A, patients received an intravenous NAC infusion (50 mg/kg) after induction of anaesthesia. These patients additionally received two intravenous doses of NAC on postoperative days 1 and 2. Patients in group B received normal saline (as a placebo) with the same volume, during the same time interval. During the first three days after surgery, postoperative AF (POAF) was assessed by continuous electrocardiogram monitoring; serum high-sensitivity C-reactive protein (hsCRP) level was also assessed before and three days after surgery.
During follow-up, 17 patients (17/141, 12.1%) developed POAF. POAF occurred in four (5.6%) patients in the NAC group and 13 (18.8%) patients in the placebo group (OR 0.23; 95% CI 0.08-0.82; p = 0.02). In the multivariable logistic regression analysis, the only predictor of AF after CABG surgery was the use of NAC (OR 0.21; 95% CI 0.06-0.73; p = 0.01). Also, the hsCRP level trend in the NAC group was different from the trend in the control group (group time interaction or interaction effect) (p < 0.001).
It seems that perioperative intravenous NAC therapy can be effectively used to reduce inflammation and the incidence of POAF after CABG surgery. The clinical trial registration number: IRCT2015040921669N1.
心房颤动（AF）是冠状动脉旁路移植（CABG）手术后最常发生的心律失常之一。
本研究旨在评估静脉注射 N-乙酰半胱氨酸（NAC）对预防 CABG 手术后 AF 的作用。
在一项双盲、随机对照试验中，共有 150 名计划行体外循环 CABG 手术的患者被随机分为两组。在 A 组中，患者在麻醉诱导后接受静脉注射 NAC 输注（50mg/kg）。这些患者在术后第 1 天和第 2 天还额外接受了两次静脉 NAC 剂量。B 组患者在相同的时间间隔内接受相同体积的生理盐水（安慰剂）。在手术后的头三天，通过连续心电图监测评估术后心房颤动（POAF）；还在术前和术后三天评估血清高敏 C 反应蛋白（hsCRP）水平。
在随访期间，17 名患者（17/141，12.1%）发生 POAF。NAC 组有 4 名（5.6%）患者发生 POAF，安慰剂组有 13 名（18.8%）患者发生 POAF（OR 0.23；95%CI 0.08-0.82；p = 0.02）。在多变量逻辑回归分析中，CABG 手术后 AF 的唯一预测因子是 NAC 的使用（OR 0.21；95%CI 0.06-0.73；p = 0.01）。此外，NAC 组的 hsCRP 水平趋势与对照组不同（组间时间交互作用或交互效应）（p < 0.001）。
围手术期静脉内 NAC 治疗似乎可以有效减少 CABG 手术后的炎症和 POAF 发生率。临床试验注册号：IRCT2015040921669N1。
