Use of nifedipine to decrease ischemic-reperfusion injury in the surgical setting.
Use of nifedipine to decrease ischemic-reperfusion injury in the surgical setting.
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DOI：
10.1016/0002-9149(85)90621-6
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发表时间：
1985-01
期刊：
影响因子：
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通讯作者：
R. E. Clark;I. Christlieb;J. C. Vanderwonde;P. D. Henry
中科院分区：
文献类型：
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作者：
R. E. Clark;I. Christlieb;J. C. Vanderwonde;P. D. Henry
本报告总结了为硝苯地平在冷高钾停搏液中的随机临床试验提供基础的研究。来自常温、离体兔心脏研究的数据表明，在持续低流量期间灌流液中存在微摩尔浓度的硝苯地平，或在全脑缺血期间将硝苯地平用作冲剂可阻止收缩和舒张期僵硬的增加，这可能与剂量和防止细胞内钙积累有关。在造成局部缺血的开胸犬身上的其他研究表明，在缺血和再灌流期间输注硝苯地平在保存血流动力学变量和减少心肌损伤方面优于硝普钠。此外，在犬的体外循环实验中，在37、28、18和12°C的心肌温度下进行的全球缺血1、2和3小时的数据都显示出显著的效果。到目前为止，随机临床试验表明，高危患者的低心输出量综合征的发生率略有下降。接受硝苯地平治疗的患者血流动力学变量有所改善。核素焦磷酸核素扫描显示，治疗组术后无心肌损伤。这项试验的结论是，当硝苯地平加入冷的高钾停搏液中时，是有效的。然而，观察到的反应似乎与剂量、载体和物种有关。
This report summarizes studies that provided a basis for a randomized clinical trial of nifedipine in cold hyperkalemic cardioplegic solution. Data from normothermic, isolated working rabbit heart studies demonstrated that presence of micromolar concentrations of nifedipine in the perfusate during continuous low flow or nifedipine used as bolus washouts during global ischemia prevented increases in systolic and diastolic stiffness, which could be related to dose and prevention of intracellular accumulation of calcium. Other studies in open-chest dogs in whom regional ischemia was produced showed that nifedipine was superior to sodium nitroprusside when infused during the ischemic and reperfusion intervals with respect to preservation of hemodynamic variables and reduction of myocardial injury. Further, data from cardiopulmonary bypass experiments in dogs conducted at myocardial temperatures of 37,28,18 and 12 °C with 1, 2 and 3 hours of global ischemia all demonstrated significant efficacy.To date, the randomized clinical trial has shown a small reduction in the incidence of low cardiac output syndrome in high-risk patients. Those receiving nifedipine had improved hemodynamic variables. No patient in the treated group had myocardial injury in the postoperative interval shown by radionuclide pyrophosphate scan. The conclusions from this trial are that nifedipine was efficacious when included in a cold hyperkalemic cardioplegic solution. The responses observed, however, appear to be dose-, vehicle- and species-dependent.