DILTIAZEM PROVIDES ANTIISCHEMIC AND ANTIARRHYTHMIC PROTECTION IN PATIENTS UNDERGOING CORONARY-BYPASS GRAFTING

被引：31

作者：

HANNES, W ^{[1
]}

FASOL, R ^{[1
]}

ZAJONC, H ^{[1
]}

SCHINDLER, M ^{[1
]}

SCHUMACHER, B ^{[1
]}

SCHLOSSER, V ^{[1
]}

HOLUBARSCH, CH ^{[1
]}

SEITELBERGER, R ^{[1
]}

机构：

[1] UNIV FREIBURG,DEPT CARDIOVASC SURG,W-7800 FREIBURG,GERMANY

来源：

EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY | 1993年 / 7卷 / 05期

关键词：

DILTIAZEM; CORONARY BYPASS SURGERY; MYOCARDIAL ENZYMES; HOLTER MONITORING;

D O I：

10.1016/1010-7940(93)90211-S

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

In 91 patients undergoing elective coronary bypass grafting, the anti-ischemic and anti-arrhythmic efficacy of a 24-hour infusion of either the calcium antagonist diltiazem (0.1 mg/kg per h, n = 44) or nitroglycerin (1 mug/kg per min, n = 47) were compared. Myocardial ischemia was diagnosed by Holter monitoring and the repeated assessment of 12-lead ECG and serum enzyme levels and defined as a transient ischemic event, transient coronary spasm or myocardial infarction. The two groups did not differ with respect to preoperative and operative data. Postoperatively, the average heart rate and pulse pressure rate were significantly lower in the diltiazem group. The incidence of postoperative atrial fibrillation (4.5 vs 19.1 %, P < 0.01), transient coronary spasm (2.3 vs 11.4 %, P < 0.05) and myocardial infarction (4.5 vs 8.5 %, not significant) and the frequency of ventricular premature couplets/h (12.1 +/- 4.5 vs 18.1 +/- 5.1, P < 0.05) and ventricular runs/h (2.5 +/- 0.8 vs 6.5 +/- 2.8, P < 0.05) were lower in the diltiazem as compared to the nitroglycerin group. In addition, diltiazem-treated patients had significantly lower postoperative peak values of creatine kinase-MB (19.3 +/- 11.6 vs 29.3 +/- 20.6, P < 0.05). In conclusion, perioperative infusion of diltiazem is effective in reducing the incidence and extent of arrhythmias and myocardial ischemia in patients undergoing elective coronary bypass grafting as compared to patients receiving nitroglycerin.

引用

页码：239 / 245

页数：7

共 34 条

[1]

Airaksinen K., Iksheimo M.J., Takkunen J.T., Heart rate after coronary bypass grafting, Am J Cardiol, 60, pp. 1395-1397, (1987)

[2]

Ball R.M., Bathe R.J., Distribution of myocardial blood flow in the exercising dog with restricted coronary inflow, Circ Res, 38, pp. 60-66, (1976)

[3]

Bulkley B.H., Hutchins G.M., Myocardial consequences of coronary artery bypass graft surgery - the paradox of necrosis in areas of revascularization, Circulation, 56, pp. 906-913, (1977)

[4]

Chaffman M., Brodgen R.N., Diltiazem: A review of its pharmacological properties and therapeutic efficacy, Drugs, 29, pp. 387-454, (1985)

[5]

Daily P.O., Jones B., Folkerth T.L., Dembitsky W.P., Moores W.Y., Reichman T.R., Comparison of myocardial temperatures with multi dose cardioplegia versus single dose cardioplegia and myocardial surface cooling during coronary bypass grafting, J Thorac Cardiovasc Surg, 97, pp. 715-724, (1989)

[6]

Devine J.E., Wiens R.D., Halstead J.M., Codd J.E., Quantization of CK MB release: Diagnostic utility in coronary bypass grafting, Clin Chim Acta, 156, pp. 145-150, (1986)

[7]

Donegani E., Costa P., De Paulis R., Di S.M., Poletti G.A., Pignatelli M.G., Verdecchia C., Morea M., Myocardial protection by perioperative diltiazem drip: A clinical evaluation, Thorac Cardiovasc Surg, 34, pp. 168-171, (1986)

[8]

Force T., Hibberd P., Weeks G., Kemper A.J., Bloomfield P., Tow D., Josa M., Khuri S., Parisi A.F., Perioperative myocardial infarction after coronary artery bypass surgery, Circulation, 82, pp. 903-912, (1990)

[9]

Gottlieb S.O., Gerstenblith G., Safety of acute calcium antagonist withdrawal: Studies in patients with unstable angina withdrawn from nifedipine, Am J Cardiol, 55, pp. 27-30, (1985)

[10]

Giilker H., Ketteler T.H., Antiarrhythmische Wirkungen der Kalziumantagonisten, Z Kardiol, 78, pp. 49-54, (1989)

← 1 2 3 4 →