在单夹技术冠状动脉旁路移植术中，主动脉钳夹前进行终末非心脏停搏温血灌流能否改善心跳恢复？一项随机对照试验。

Can heartbeat recovery be improved with terminal non-cardioplegic warm blood perfusion prior to aortic unclamping in single-clamp technique coronary artery bypass surgery? A randomized controlled trial.

机构信息

Division of Cardiothoracic Surgery, Department of Surgery, Faculty of Medicine, Thammasat University, 95 Phahonyothin Road, Khlong Nueng, Khlong Luang, Pathum Thani, 12120, Thailand.

出版信息

J Cardiothorac Surg. 2024 Aug 22;19(1):486. doi: 10.1186/s13019-024-03006-0.

DOI:10.1186/s13019-024-03006-0

PMID:39169416

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11340034/

Abstract

BACKGROUND

The objective of this study is to investigate whether the use of antegrade perfusion with terminal non-cardioplegic warm blood (TNWB) before aortic unclamping in single-clamp technique coronary artery bypass has a positive impact on intraoperative heartbeat recovery.

METHODS

Between December 2022 and May 2023, 40 consecutive patients undergoing coronary artery bypass using single-clamp technique were randomized into one of two groups: the TNWB group received an antegrade perfusion with TNWB before removing the aortic cross-clamp (n = 20), while the control group did not receive (n = 20). The time intervals between coronary perfusion and the onset of the first heartbeats and sinus rhythms, occurrences of spontaneous sinus rhythm, intraoperative defibrillation requirements, as well as postoperative CK-MB and troponin T levels were recorded and subjected to analysis.

RESULTS

In the TNWB group, the median onset of the first heartbeats after the initiation of coronary perfusion was 34 s (4-100), while in the control group, it was 90 s (15-340) (p < 0.001). The median onset of the sinus rhythms was 100 s (28-290) in the TNWB group and was 132 s (45-350) in the control group (p = 0.023). The occurrence of intraoperative arrhythmias was 15% in the TNWB group compared to 50% in the control group (p = 0.018), and the incidence for internal defibrillation was 5% in the TNWB group and was 30% in the control group (p = 0.037). The TNWB group showed the median CK-MB levels at 6 h postoperative was 14.10 ng/mL (9.78-19.26), compared to 18.31 ng/mL (13.98-23.80) in the control group (p = 0.045).

CONCLUSIONS

During single clamp coronary artery bypass, administration TNWB into the aortic root before aortic unclamping has the potential to enhance heartbeat recovery, as evidenced by the shortened time to the initial heartbeat and the establishment of sinus beats following coronary perfusion.

TRIAL REGISTRATION

Trial registration number (Study ID): TCTR20231002003.

摘要

背景

本研究旨在探讨在单根夹技术冠状动脉旁路移植术中，主动脉阻断前使用顺行灌流终末非心脏停搏温热血（TNWB）对术中心跳恢复是否有积极影响。

方法

2022 年 12 月至 2023 年 5 月，40 例连续接受单根夹技术冠状动脉旁路移植术的患者随机分为两组：TNWB 组在移除主动脉钳夹前给予 TNWB 顺行灌流（n=20），对照组不给予（n=20）。记录并分析冠状动脉灌注与首次心跳和窦性节律出现之间的时间间隔、自发窦性节律的发生、术中除颤需求以及术后 CK-MB 和肌钙蛋白 T 水平。

结果

TNWB 组冠状动脉灌注后首次心跳出现的中位数时间为 34 秒（4-100），对照组为 90 秒（15-340）（p<0.001）。TNWB 组窦性节律出现的中位数时间为 100 秒（28-290），对照组为 132 秒（45-350）（p=0.023）。TNWB 组术中心律失常发生率为 15%，对照组为 50%（p=0.018），TNWB 组内部除颤发生率为 5%，对照组为 30%（p=0.037）。TNWB 组术后 6 小时 CK-MB 中位数水平为 14.10ng/mL（9.78-19.26），对照组为 18.31ng/mL（13.98-23.80）（p=0.045）。