Amano H, Okuda M, Furuhashi K, Utsunomiya H, Nakai Y, Muneyuki M
Department of Anesthesiology, Mie University School of Medicine, Tsu.
Masui. 1995 Apr;44(4):594-6.
We evaluated retrospectively the benefit of prophylactic nitroglycerin (TNG) infusions during elective coronary artery bypass grafting (CABG) in 73 patients. In all patients anesthesia was maintained with high dose fentanyl. Thirty-seven patients were infused TNG 0.3 microgram.kg-1.min-1 during surgery and 36 patients were not. The TNG-infused patients demonstrated lower perfusion pressure during cardiopulmonary bypass (CPB) and higher incidence of inotropic administrations than the uninfused patients. Serum myocardial creatine phosphokinase (CPK-MB) levels of TNG-infused patients were higher than those of TNG-uninfused patients on the first postoperative day. We speculate that inotropic administrations under low myocardial perfusion pressure at the time of weaning from CPB induces myocardial ischemia which in turn causes an increase in serum CPK-MB level. We conclude that prophylactic administration of TNG does not prevent perioperative ischemia during CABG.
我们回顾性评估了73例择期冠状动脉旁路移植术（CABG）患者术中预防性输注硝酸甘油（TNG）的益处。所有患者均采用大剂量芬太尼维持麻醉。37例患者在手术期间以0.3微克·千克⁻¹·分钟⁻¹的速度输注TNG，36例患者未输注。与未输注TNG的患者相比，输注TNG的患者在体外循环（CPB）期间灌注压较低，使用血管活性药物的发生率较高。术后第1天，输注TNG患者的血清心肌肌酸磷酸激酶（CPK-MB）水平高于未输注TNG的患者。我们推测，在CPB脱机时心肌灌注压较低的情况下使用血管活性药物会诱发心肌缺血，进而导致血清CPK-MB水平升高。我们得出结论，预防性给予TNG不能预防CABG围手术期缺血。
