低剂量内西里和功能障碍患者接受心肺旁路手术的功能维护:双盲安慰剂控制试点研究
Horng H Chen1, Thoralf M Sundt, David J Cook
1Department of Internal Medicine and Division of Cardiovascular Diseases, Mayo Clinic and Foundation, 200 First St SW, Rochester, MN 55905, USA. chen.horng@mayo.edu
Circulation
|September 14, 2007
概括
在接受心脏手术的患有功能不全的患者中,外科手术期间的尼西里蒂德显示出生物活性. 低剂量的内西里提德可以保持功能,与安慰剂不同,表明潜在的临床益处.
科学领域:
- 心脏病学 心脏病学
- 腎臟病學 (nephrology) 是一種醫學專業.
- 麻醉学 麻醉学
背景情况:
- 功能衰竭增加了心肺绕道 (CPB) 心脏手术的风险.
- B型尿素 (BNP) 可以改善功能并抑制阿尔多.
- 血囊是功能比肌素更准确的标志物.
研究的目的:
- 评估经手术期间低剂量内西里的生物活性和对功能的影响,用于接受CPB治疗的功能不良患者.
- 评估内西里提德对血BNP,cGMP,cystatin,aldosterone和肌素清除的影响.
主要方法:
- 一个双盲,安慰剂控制的试点研究.
- 40名患有手术前功能衰竭 (肌素清除率<60毫升/分钟) 的患者接受CPB.
- 随机分配给安慰剂 (n=20) 或静脉内西里蒂德 (n=20;0.005微克/千克/分钟) 在24小时内.
主要成果:
- 涅西里提德增加了血BNP和cGMP,并降低了血囊.
- 在安慰剂组观察到阿尔多斯特激活,但在涅西里提德组没有.
- 尼西里提德组的功能得到保护,肌素清除量没有显著下降或囊素增加.
结论:
- 在接受CPB的患有功能不全的患者中,低剂量内西里蒂德在外科手术期间具有生物活性.
- 尼西里提德的使用导致了血囊酸水平的降低.
- 需要进一步的研究来确认这些影响是否转化为改善临床结果.
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