【摘要】 目的　探讨体外循环下行冠状动脉旁路移植术 (CABG)时在围手术期经静脉给予钙拮抗剂地尔硫 ,对心肌保护的作用。方法　选取 4 0例患者 ,随机分为试验组 (2 0例 )和对照组 (2 0例 )。对照组常规处理 ;实验组的患者从体外循环开始至主动脉阻断后的 2 4h ,持续输入盐酸地尔硫 0 .1mg·kg-1·h-1。分别于CABG术前和撤除主动脉阻断钳后第 1、2、4、8、12、16、2 0h及 2 4h进行血液动力学监测和心肌酶学监测。结果　 (1)在撤除主动脉阻断钳后 4～ 4 8h内 ,试验组的平均心率和心率收缩压乘积 (RPP)始终维持在相对较低的水平。 (2 )两组间所有患者的CK峰值差异无显著意义 ,对照组的CK MB及心肌肌钙蛋白T(cTNT)峰值明显较高。出现冠状动脉痉挛的患者中 ,对照组其CK、CK MB和cTNT值均明显的高于实验组。 (3)实验组的患者其平均每小时发生的心律失常的次数明显少于对照组 ,尤其是在ST段压低期间 ,平均每小时室性心律失常的发生次数明显低于对照组。结论　对行体外循环下冠状动脉旁路移植术患者 ,地尔硫是一种有效的心肌保护药物。更多还原

【Abstract】 Objective To evaluate the cardioprotective effects of intravenous diltiazem infusion perioperatively in patients undergoing coronary artery bypass grafting (CABG) under extracorporeal circulation. Methods Forty patients undergoing CABG were divided into 2 groups of 20 patients according to the operation date: experimental group in which infusion of diltiazem (0.1 mg/kg/h) was given starting from the onset of extracorporeal circulation until 24 h after the aortic cross-clamping, and blank control group. The relative hemodynamic parameters were recorded for 48 hours. Results (1) 4～24 hours after the aortic cross-clamping the heart rates of the experimental group was 98±18 ～96±13 times/min, significantly lower than those of the control group (111±16～105±14 tomes/min, P <0.05); the values of rate-pressure product (RPP) of the experimental group were 13.0±3.7～11.7±3.0 mm Hg/min/10 3, significantly lower than those of the control group (14.1±1.9～5.8±3.6～ mm Hg/min/10 3, P <0.05)(2)The postoperative peak value of creatine kinase (CK) was not significantly different between these 2 groups. The postoperative peak value of creatine kinase-MB (CK-MB) in the experimental group was 83±33 IU/L, significantly lower than that in the control group (105±20 IU/L, P <0.05) and postoperative peak value of cardiac troponin-T (cTNT) was 0.38±0.21 IU/L, significantly lower than that in the control group (0.83±0.20 IU/L, P <0.05). The values of CK, CK-MB, and cardiac troponin TC (cTNT) of the patients with coronary vasospasm in the experimental group were all significantly lower than those of the patients with coronary vasospasm in the control group. (3) The average number of arrhythmic events per hour was lower in diltiazem group, and the average number of ventricular premature contraction per hour was significantly lower during the period of ST segment depression in particular. Conclusion Perioperative intravenous diltiazem infusion provides significant cardioprotective effect in patients undergoing CABG.更多还原