尼可地尔对不停跳冠脉移植术中患者血流动力学和心肌肌钙蛋白Ⅰ的影响

Effect of Nicorandil on the Hemodynamics and cTnⅠ in Patients Undergoing Off-pump Coronary Artery Bypass Graft

关键词:  血流动力学  尼可地尔  冠脉旁路移植术  心肌肌蛋白Ⅰ

Key words:  hemodynamic  nicorandil  coronary artery bypass grafit  cTnⅠ

摘要:

目的 观察尼可地尔对不停跳冠脉移植术中患者血流动力学和心肌肌钙蛋白Ⅰ(cTnⅠ)的影响。方法 60例择期行不停跳冠脉旁路移植术患者，随机分为对照组(Ⅰ组)，尼可地尔10 mg舌下含服组(Ⅱ组)、尼可地尔10 mg舌下含服加20 mg静脉泵注组(Ⅲ组)、尼可地尔20 mg静脉泵注组(Ⅳ组)。分别在麻醉诱导建立监测即刻(T₀)、泵注完尼可地尔或生理盐水后(T₁)、冠脉移植完毕1，2，4，12，24 h(分别记为T₂，T₃，T₄，T₅，T₆)记录心率(HR)、平均动脉压(MAP)、心指数(CI)、肺毛细血管契压(PCWP)，同时取静脉血测定心肌肌钙蛋白Ⅰ(cTnⅠ)含量。结果 4组间HR，MAP，PCWP无明显差异(P>0.05)；T₄~T₅时，Ⅱ，Ⅲ，Ⅳ组CI明显高于Ⅰ组(P<0.05)，Ⅲ组明显高于Ⅱ，Ⅳ组(P<0.05)；T₄时，Ⅱ，Ⅲ组cTnⅠ明显低于Ⅰ，Ⅳ组，T₅~T₆时Ⅱ，Ⅲ，Ⅳ组cTnⅠ明显低于Ⅰ组(P<0.05)；Ⅲ组明显低于Ⅱ，Ⅳ组。结论 尼可地尔可改善不停跳冠脉旁路移植术患者心脏功能和心肌受损的程度，且和剂量及用药时机有关，对血流动力学无不利影响。

Abstract:

OBJECTIVE To observe the effect of nicorandil on the hemodynamics and cTnⅠ in patients undergoing off-pump coronary artery bypass graft(OPCABG). METHODS Sixty scheducled patients were randomly divided into group control(Ⅰ), group nicorandil(Ⅱ, Ⅲ and Ⅳ). In group Ⅱ,10 mg nicorandil was oral administered before operation; whereas in group Ⅲ, the same dosage nicorandil was administered before operation, then 20 mg nicorandil was injected introvenously after induction of anesthesia; in group Ⅳ, 20 mg nicorandil was injected intravenously after operation. The concentration of cTnⅠ was determined at the following time points: after induction(T₀), the ending injecting of nicorandil or normal sailine(T₁), 1 h(T₂), 2 h(T₃), 4 h(T₄), 12 h(T₅), 24 h(T₆) after revascularization. RESULTS There was no difference among the four groups in HR, MAP, PCWP. Cardiac index (CI) in group Ⅱ, Ⅲ, Ⅳ was significantly higher at T₄-T₅ compared with groupⅠ(P<0.05); CI in group Ⅲ at T₄-T₅ was higher compared with group Ⅱ, Ⅳ (P<0.05). The concentration of plasma cTnⅠ in group Ⅱ and Ⅲ was significantly lower at T₄ compared with group Ⅰ, Ⅳ, whereas it was lower at T₅-T₆ in group Ⅱ, Ⅲ, Ⅳ compared with group Ⅰ; and in group Ⅲ, it was obviously lower than in group Ⅱ, Ⅳ. CONCLUSION Nicorandil can benefit the cardiac function and decrease myocardil injury in OPCABG patients with dose-response relationship in the hemodynamics condictions.