在人类冠状动脉旁路手术中进行远程缺血预约:从承诺到失望?
Ishtiaq A Rahman1, Jorge G Mascaro, Rick P Steeds
1Department of Cardiothoracic Surgery, University Hospital Birmingham NHS Trust, Edgbaston, Birmingham, UK.
Circulation
|September 15, 2010
概括
远程缺血预调 (RIPC) 在动冠状动脉手术期间没有显示保护心脏,脏或肺部的好处. 这项大型试验发现,与安慰剂相比,素释放或器官功能没有显著差异.
科学领域:
- 心脏病学 心脏病学
- 心血管外科心血管外科
- 缺血预先调节 缺血预先调节
背景情况:
- 在冠状动脉旁路移植 (CABG) 携带心肌,和肺损伤的风险.
- 远程缺血预制 (RIPC) 是一个潜在的策略,以减轻外科手术期间的器官损伤.
研究的目的:
- 评估RIPC在为接受动冠状动脉手术的患者提供心肌,和肺部保护方面的有效性.
- 评估RIPC对心脏生物标志物,血液动力学稳定性和手术后器官功能的影响.
主要方法:
- 一个单中心,前性,随机 (1:1),安慰剂对照试验,涉及失明的参与者和医疗保健团队.
- 在大动脉紧之前,使用上肢袖口膨胀进行了RIPC;对照组接受了安慰剂.
- 主要终点是托洛T (cTnT) 的48小时曲线下的面积 (AUC);次要终点包括心脏指数,功能和肺损伤标志物.
主要成果:
- 在RIPC和安慰剂组之间48小时AUC cTnT没有显著差异 (28对30 ng/mL(-1)/48小时(-1)).
- 二级终点,包括峰值cTnT,心脏指数,内/血管压缩剂使用,功能障碍 (肌素,透析) 和肺损伤 (PaO2:FiO2比率) 在各组之间相似.
- 住院生存率很高 (99.4%),没有与RIPC相关的显著差异.
结论:
- 与较小的研究结果相反,RIPC没有在减少心肌损伤,改善血液动力学或增强脏和肺部保护方面显示出显著的益处.
- 这项研究表明,在动冠状动脉手术期间,RIPC可能无法有效地保护器官.
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