Podesser B K, Schwarzacher S, Zwoelfer W, Binder T M, Wolner E, Seitelberger R
Department of Cardiothoracic Surgery, University of Vienna, Austria.
J Thorac Cardiovasc Surg. 1995 Nov;110(5):1461-9. doi: 10.1016/S0022-5223(95)70069-2.
A randomized study was performed on 70 patients undergoing elective coronary bypass grafting to examine whether the combined infusion of the calcium channel blocker nifedipine (10 micrograms/kg per hour) and the beta 1-blocker metopropol (12 micrograms/kg per hour, n = 34) reduces the prevalence of perioperative myocardial ischemia and arrhythmias. The control group received nifedipine alone (n = 36). In both groups the infusion was started from the onset of extracorporal circulation and maintained over a period of 24 hours. Repeated 12-lead electrocardiographic and 3-channel Holter monitor recordings for 48 hours were used to define perioperative myocardial ischemia (transient ischemic event, myocardial infarction) and arrhythmias (sinus tachycardia, supraventricular tachycardia, atrial flutter/fibrillation, ventricular tachycardia). Hemodynamic parameters were repeatedly assessed for 24 hours and serum enzyme levels (creatine kinase, MB isoenzyme of creatine kinase) for up to 36 hours after the operation. The two groups did not differ significantly with respect to preoperative anamnestic and surgical data. No signs of perioperative myocardial infarction were detected in either group. However, a significantly lower incidence of transient ischemic episodes was observed in the nifedipine-metoprolol group than in the nifedipine group (3% vs 11%; p < 0.05). In addition, there was a tendency toward lower creatine kinase MB levels and peak values of creatine kinase and creatine kinase MB in the nifedipine-metoprolol group. With regard to perioperative arrhythmias, there was a significantly lower incidence of sinus tachycardia and atrial flutter/fibrillation in the nifedipine-metoprolol group (9% and 6%) than in the nifedipine group (33% and 27%, p < 0.05). In addition, postoperative heart rate was lower in the nifedipine-metoprolol group starting from the sixth hour after release of the aortic crossclamp (p < 0.05 and p < 0.01, respectively). No other hemodynamic parameters showed significant differences between the two groups and all returned to preoperative levels within 24 hours. In conclusion, perioperative application of nifedipine and metoprolol in patients undergoing elective coronary bypass grafting reduces the prevalence of perioperative myocardial ischemia and arrhythmias without significant negative inotropic effects. The combined infusion of the two drugs appears superior to nifedipine alone in preventing perioperative myocardial ischemia and reducing reperfusion-induced arrhythmias.
对70例行择期冠状动脉搭桥术的患者进行了一项随机研究，以检验钙通道阻滞剂硝苯地平（每小时10微克/千克）和β1受体阻滞剂美托洛尔（每小时12微克/千克，n = 34）联合输注是否能降低围手术期心肌缺血和心律失常的发生率。对照组仅接受硝苯地平（n = 36）。两组均在体外循环开始时开始输注，并维持24小时。通过重复记录12导联心电图和进行48小时的三通道动态心电图监测来确定围手术期心肌缺血（短暂性缺血事件、心肌梗死）和心律失常（窦性心动过速、室上性心动过速、心房扑动/颤动、室性心动过速）。术后24小时内反复评估血流动力学参数，术后36小时内评估血清酶水平（肌酸激酶、肌酸激酶MB同工酶）。两组在术前病史和手术数据方面无显著差异。两组均未检测到围手术期心肌梗死的迹象。然而，硝苯地平 - 美托洛尔组短暂性缺血发作的发生率显著低于硝苯地平组（3%对11%；p < 0.05）。此外，硝苯地平 - 美托洛尔组肌酸激酶MB水平以及肌酸激酶和肌酸激酶MB的峰值有降低趋势。关于围手术期心律失常，硝苯地平 - 美托洛尔组窦性心动过速和心房扑动/颤动的发生率显著低于硝苯地平组（9%和6%）（33%和27%，p < 0.05）。此外，从主动脉阻断钳松开后第6小时开始，硝苯地平 - 美托洛尔组的术后心率较低（分别为p < 0.05和p < 0.01）。两组之间的其他血流动力学参数无显著差异，且所有参数在24小时内均恢复到术前水平。总之，在择期冠状动脉搭桥术患者中围手术期应用硝苯地平和美托洛尔可降低围手术期心肌缺血和心律失常的发生率，且无显著的负性肌力作用。两种药物联合输注在预防围手术期心肌缺血和减少再灌注诱导的心律失常方面似乎优于单独使用硝苯地平。
