在非体外循环冠状动脉旁路移植术(OPCAB)中保持低左心房压力(LAP)是可取的。这项研究是为了比较左西孟旦或米力农对OPCAB不同阶段LAP的影响。
■机构伦理委员会批准后,这项双臂双盲随机对照试验是在IPGME&R的心脏OT接受OPCAB的44例三血管冠状动脉疾病成年患者中进行的,加尔各答.患者随机分为两组,术中接受左西孟旦或米力农。比较肺毛细血管楔压(PCWP)作为主要结果参数,尽管在OPCAB的六个阶段中还评估了其他超声心动图和血液动力学参数,也就是说,胸骨切开术后,近端,左前降支(LAD),钝角边缘(OM),后降支动脉(PDA)移植,在胸骨闭合之前。使用Student's非配对双尾t检验比较数值参数。
■发现左西孟旦组近端的PCWP显着降低(P<0.05)(P=0.047),LAD(P=0.018),OM(P<0.0001),PDA嫁接(P=0.028),和胸骨闭合前(P=0.015)。其他参数表示LAP,也就是说,从二尖瓣舒张早期流入速度到二尖瓣环舒张早期速度比(E/E'),这表明左西孟旦组LAP在LAD期间明显降低,OM,和胸骨闭合前的PDA移植。结论:左西孟旦可作为一种主要的促效药,在OPCAB的不同阶段能更好地降低左心房压力。转化为左心室舒张末期压的降低,因此保持最佳的冠状动脉灌注压,这是手术的主要目标。
Maintaining a low left atrial pressure (LAP) in off-pump coronary artery bypass grafting (OPCAB) is desirable. This study was done to compare the effects of intravenous levosimendan or milrinone on LAP at different stages of OPCAB.
After institutional ethics committee clearance, this two-arm double-blind randomized control trial was done in 44 adult patients with triple vessel coronary artery disease undergoing OPCAB at cardiac OT of IPGME&R, Kolkata. The patients were randomly allocated into two groups receiving intraoperative either levosimendan or milrinone. Pulmonary capillary wedge pressure (PCWP) was compared as the primary outcome parameter, whereas other echocardiographic and hemodynamic parameters were also assessed during six stages of OPCAB, that is, after sternotomy, proximal(s), left anterior descending artery (LAD), obtuse marginal (OM), posterior descending artery (PDA) grafting, and before sternal closure. Numerical parameters were compared using Student\'s unpaired two-tailed t-test.
PCWP was found to be significantly lower (P < 0.05) in the levosimendan group during proximal (P = 0.047), LAD (P = 0.018), OM (P < 0.0001), PDA grafting (P = 0.028), and before sternal closure (P = 0.015). Other parameters indicate LAP, that is, from mitral early diastolic inflow velocity to mitral annular early diastolic velocity ratio (E/e\'), which indicated significantly lower LAP in levosimendan group during LAD, OM, and PDA grafting and before sternal closure. Conclusion: Levosimendan may be used as a primary inotrope in terms of better reduction in left atrial pressure during different stages of OPCAB, translating to a decrease in left ventricular end-diastolic pressure, therefore maintaining optimum coronary perfusion pressure, which is the primary goal of the surgery.