Ischemic preconditioning prior to myocardial protection with cold blood cardioplegia in coronary surgery
Ischemic preconditioning prior to myocardial protection with cold blood cardioplegia in coronary surgery
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DOI：
10.1016/s1010-7940(97)00255-8
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发表时间：
1997-11-01
影响因子：
3.4
通讯作者：
Haverich, A
中科院分区：
文献类型：
--
作者：
Cremer, J;Steinhoff, G;Haverich, A
目的：在梗死、顿晕或长时间缺血的实验模型中，心肌预处理的令人鼓舞的结果提出了预处理技术是否可以增强用于常规冠状动脉手术的传统心脏停搏保护的问题。方法：进行了一项前瞻性临床试验，研究在心脏停跳前应用冷血心脏停跳液对计划进行常规冠状动脉手术的患者（3 支血管疾病，左心室射血分数 > 50%）进行额外的缺血常温预处理的效果。应用两次 5 分钟的交叉钳夹周期，心脏以窦性节律跳动，然后再灌注 10 分钟，每次（n = 7，第 I 组）。顺行输送诱导中度低温的冷血心脏停跳液。在对照组中，单独使用冷间歇性血液停跳液（n = 7，第 II 组）。分析 1、3、6、9 和 12 小时时冠状窦流出物的肌酸激酶 (CK)、CK-MB、乳酸和肌钙蛋白 T 的释放情况。此外，还监测术后儿茶酚胺的需求。结果：手术耐受性良好，所有研究组均未发生围手术期心肌梗死。第一组的乳酸浓度往往较高，但这种差异并不显着。此外，CK、CK-MB 和肌钙蛋白 T 的浓度没有发现显着差异。缺血预处理后，术后前 12 小时内需要增加多巴胺剂量（I 组：2.63 +/- 1.44 μg/kg/min，II 组：0.89 +/- 1.06 μg/kg/min）。结论：与单独使用冷血心脏停跳液的心脏停跳保护相比，将缺血预处理和心脏停跳保护与冷血心脏停跳液相结合似乎并不能改善心肌保护。相反，当应用这种缺血预处理方案时，收缩功能似乎受到损害。 (C) 1997 Elsevier Science B.V.
Objective: Encouraging results on myocardial preconditioning in experimental models of infarction, stunning or prolonged ischemia raise the question whether preconditioning techniques may enhance conventional cardioplegic protection used for routine coronary surgery. Methods: A prospective clinical trial was conducted to investigate the effect of additional ischemic normothermic preconditioning prior to cardioplegic arrest applying cold blood cardioplegia in patients scheduled for routine coronary surgery (3 vessel disease, left ventricular ejection fraction > 50%). Two cross clamp periods of 5 min with the hearts beating in sinus rhythm were applied followed by 10 min of reperfusion, each (n = 7, group I). Inducing moderate hypothermia cold blood cardioplegia was delivered antegradely. In control groups, cold intermittent blood cardioplegia (n = 7, group II) was used alone. Coronary sinus effluents were analyzed for release of creatine kinase (CK), CK-MB, lactate, and troponin T at 1, 3, 6, 9, and 12 h. In addition, postoperative catecholamine requirements were monitored. Results: The procedure was tolerated well, and no perioperative myocardial infarction in any of the groups studied occurred. Concentrations of lactate tended to be higher in group I, but this difference was not significant. In addition, no significant differences for concentrations of CK, CK-MB, and troponin T were found. Following ischemic preconditioning an increased dosage of dopamine was required within the first 12 h postoperatively (group I: 2.63 +/- 1.44 mu g/kg/min, group II: 0.89 +/- 1.06 mu g/kg/min). Conclusions: Combining ischemic preconditioning and cardioplegic protection with cold blood cardioplegia does not appear to ameliorate myocardial protection when compared to cardioplegic protection applying cold blood cardioplegia alone. Inversely, contractile function seemed to be impaired when applying this protocol of ischemic preconditioning. (C) 1997 Elsevier Science B.V.