术后N-乙半氨酸用于预防接受Cabg手术的高风险患者的功能障碍:一种随机对照试验
Karen E A Burns1, Michael W A Chu, Richard J Novick
1Division of Critical Care Medicine, University of Western Ontario, London, Ontario, Canada. burnske2@yahoo.ca
JAMA
|July 21, 2005
概括
在经过冠状动脉旁路移植 (CABG) 手术与心肺旁路移植 (CPB) 的高风险患者中,周术N-乙半氨酸不能预防功能障碍. 需要进一步的研究来识别有风险的患者和有效的干预措施.
科学领域:
- 心脏病学 心脏病学
- 腎臟病學 (nephrology) 是一種醫學專業.
- 手术并发症 手术并发症
背景情况:
- 功能障碍是冠状动脉旁路移植 (CABG) 手术后与心肺旁路移植 (CPB) 的重大并发症,增加患病率和死亡率.
- 作为抗氧化剂和血管扩张剂的N-乙半氨酸在抵消脏缺血和缺氧方面表现出潜力.
研究的目的:
- 评估外科手术期间静脉注射N-乙半氨酸在高风险患者中维持功能方面的疗效,这些患者接受了CPB的CABG手术.
- 为了比较N-乙半氨酸和安慰剂组之间的术后功能障碍的发生率.
主要方法:
- 一项随机,四重盲,安慰剂对照试验,涉及295名接受CABG手术的高风险患者.
- 患者在24小时内接受了四剂静脉注射N-乙半氨酸 (600毫克) 或安慰剂.
- 主要结局:患有术后功能障碍的患者比例 (肌素升高>0.5 mg/dL或5天内从基线上升25%).
主要成果:
- 在N-乙半氨酸 (29.7%) 和安慰剂 (29.0%) 组之间,术后功能障碍没有显著差异 (P = .89).
- 二次结局,包括置换疗法,不良事件和死亡率,也没有显著差异.
- 一项对基线肌素水平升高的患者的亚组分析显示,N-乙半氨酸 (25.0%对37.1%,P = .29) 的益处趋势不显著.
结论:
- 在外科手术期间使用的N-乙半氨酸并未预防高风险CABG患者的术后功能障碍,并发症或死亡.
- 需要进一步的研究来确定有风险的患者,可靠的功能障碍标志物和临床相关的值.
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