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Dexmedetomidine is an α2 adrenoceptor agonist and has cardioprotective effect,the mechanism of which is being studied.Increasing studies have proved the clinical value of dexmedetomidine in reducing postoperative complications and improving the prognosis of patients.Therefore,this review summarizes the cardiac protection mechanism of dexmedetomidine based on the existing studies and expounds the application of dexmedetomidine in the perioperative period of cardiovascular surgery.
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Humans , Dexmedetomidine/therapeutic use , HeartABSTRACT
Introducción: Una serie de breves periodos de isquemias a distancia pueden limitar el daño miocárdico producido por la isquemia/reperfusión. Objetivo: Analizar las diferencias entre los dos grupos (control y estudio) teniendo en cuanta el consumo de inotrópicos y/o vasopresores durante los períodos intra y posoperatorio, así como, incidencia de eventos adversos cardiacos mayores y mortalidad en el postoperatorio. Métodos: Se realizó un estudio cuasiexperimental, explicativo, comparativo con control histórico, en dos grupos de 247 pacientes, propuestos para revascularización coronaria. Se colocó un torniquete en el brazo derecho, en el grupo estudio, alternando 3 insuflaciones con 3 desinsuflaciones con una presión de 200 mmHg, manteniéndola 5 min cada una. Este proceder se realizó previo, durante y después del evento isquémico mayor, provocado por el pinzamiento de la arteria coronaria. Resultados: Se logró una disminución significativa del consumo de drogas inotrópicas y vasoactivas. Se comprobó además, la disminución en la incidencia de bajo gasto cardiaco reversible, fibrilación ventricular, nuevo infarto agudo de miocardio. Conclusiones: El condicionamiento isquémico a distancia es una importante herramienta a tener en cuenta para la protección cardiaca perioperatoria en la revascularización coronaria(AU)
Introduction: A series of brief distant ischemia periods can limit myocardial damage produced by ischemia or reperfusion. Objective: To analyze the differences between the two groups (control and study) taking into account the consumption of inotropics and/or vasopressors during the intraoperative and postoperative periods, as well as the incidence of major cardiac adverse events and mortality in the postoperative period. Methods: A quasiexperimental, explanatory and comparative study with historical control was conducted on two groups of 247 patients proposed for coronary revascularization. A tourniquet was placed to the right arm, in the study group, alternating three insufflations with three dessufflations with a pressure of 200 mmHg, keeping each for five minutes. This procedure was performed before, during and after the major ischemic event, caused by pinching of the coronary artery. Results: A significant decrease in the consumption of inotropic and vasoactive drugs was achieved. The decrease in the incidence of low reversible cardiac output, ventricular fibrillation, and new acute myocardial infarction was also proven. Conclusions: Distant ischemic conditioning is an important tool to be taken into account for perioperative cardiac protection in coronary revascularization(AU)
Subject(s)
Humans , Myocardial Reperfusion , Ischemic Postconditioning/methods , Ischemia/prevention & control , Myocardial Revascularization/methods , Perioperative Care/methods , Non-Randomized Controlled Trials as TopicABSTRACT
Introducción: Una serie de breves períodos de isquemias a distancia, previo al evento isquémico mayor, pueden limitar el daño miocárdico producido por la isquemia/reperfusión. Objetivo: Evaluar la utilidad del condicionamiento isquémico a distancia, en pacientes programados para procedimientos quirúrgicos de revascularización coronaria. Métodos: Se realizó un estudio cuasiexperimental, explicativo, comparativo con control histórico, en dos grupos de 247 pacientes, propuestos para revascularización coronaria. Se colocó un torniquete en el brazo derecho, en el grupo estudio, alternando 3 insuflaciones con 3 desinsuflaciones con una presión de 200 mmHg, manteniéndola 5 min cada una. Este proceder se realizó previo, durante y después del evento isquémico mayor, provocado por el pinzamiento de la arteria coronaria. Resultados: Se logró una disminución significativa de los parámetros enzimáticos. No se encontraron diferencias significativas (p>0,05) según un conjunto de variables que representan el estado inicial de los pacientes(AU)
Introduction: A series of short periods of distant ischemia, prior to the major ischemic event, can limit the myocardial damage produced by ischemia or reperfusion. Objective: To evaluate the usefulness of remote ischemic conditioning in patients scheduled for surgical procedures of coronary revascularization. Methods: A quasi-experimental, explanatory, comparative study with historical control was conducted in two groups of 247 patients proposed for coronary revascularization. A tourniquet was placed in the right arm in the study group, alternating 3 insufflations with 3 dessufflations with a pressure of 200 mmHg, keeping each for 5 minutes. This procedure was performed before, during and after the major ischemic event, caused by the impingement of the coronary artery. Results: A significant decrease in enzymatic parameters was achieved. No significant differences were found (p>0.05) according to a set of variables that represent the initial state of the patients(AU)
Subject(s)
Humans , Male , Female , Surgical Procedures, Operative/ethics , Ischemic Preconditioning/methods , Myocardial Revascularization/methods , Non-Randomized Controlled Trials as Topic , Anesthesia, Inhalation/methodsABSTRACT
Berberine is an isoquinoline alkaloid isolated from Rhizoma Coptidis and Cortex Phellodendri,which has a long medical history in China.Recent studies have indicated that berberine has multiple pharmacological activities including anti-inflammatory,anti-microorganisms,anti-cancer,cardiac protection,glucose lowering,regulating lipid metabolism and immune suppression.Berberine has been used for the treatment of intestinal infectious diseases for many years.With the continuous progress of the research,it is reported that berberine has many new clinical applications,including treatment of the cardiovascular disease,metabolic syndrome and its complications,cancers,abdominal adhesions and chlamydia trachomatis infection.This review is intended to introduce the role of berberine in various aspects of pharmacological effects,molecular mechanisms and clinical applications.
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Objective: To evaluate the effect of Shunaoxin Dropping Pill (SDP) on blood pressure and cardiac protection in spontaneously hypertensive rats (SHRs). Methods: The SHRs were randomly divided into three groups, model (M) group, SDP group, and valsartan (VL) group. Non-invasive blood pressure instrument was used to measure blood pressure. Serum content of nitric oxide synthase (NOS) and angiotensin II (Ang II) were measured using kits for 6 weeks after ig administration. Doppler echocardiography was used to evaluate left ventricular weight, and HE staining was used to assess aortic and cardiac morphology. Results: The blood pressure of SHRs decreased to minimum 1 h after ig administration of SDP (800 mg/kg). Long-term use of SDP could stabilize blood pressure of SHRs. Serum content of NOS in SDP group was significantly more than that in M group (P < 0.05). The serum content of Ang II in SDP group was significantly less than that in M group (P < 0.05). The left ventricular weight of SDP group was significantly lower than that in M group (P < 0.05). SDP administered group can improve myocardial and aortic morphology abnormalities caused by hypertension. Conclusion: SDP has a certain therapeutic effect on hypertensive with myocardial hypertrophy rats, it can be used as a potential drug on hypertensive disorders associated with cardiac hypertrophy.
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Objective: To observe the protective effect of ischemic post-conditioning on myocardial reperfusion injury with the potential mechanism in experimental rabbits. Methods: A total of 36 healthy New Zealand rabbits were divided into 6 groups:①Sham group,②Ischemic reperfusion control (CON) group,③Myocardial ischemic post-conditioning (MpostC) group,④Remote ischemic post-conditioning (RPostC) group,⑤MPostC+5-HD group,⑥RPostC+5-HD group.n=6 in each group. The ischemic reperfusion injury model was established by left ventricular descending artery occlusion for 45 min followed by reperfusion for 120 min. Bilateral external iliac artery was occluded for 5 min to induce the short skeletal muscle ischemia. The indexes of cardiac function and plasma CK , LDH activities were measured at baseline, end of ischemia and 1, 2 h after reperfusion respectively, the sizes of myocardial infarction (MI) were examined and compared among different groups. Results: ①Compared with CON group, the indexes of cardiac function were improved in MPostC and RPostC groups at 1, 2 h after reperfusion,P0.05. The MI ranges and areas in MPostC and RPostC groups were much less than that in CON group,P0.05. Conclusion: Classical ischemic post-conditioning and remote organ ischemic post-conditioning both have protective effect on myocardial reperfusion injury in experimental rabbit, which might be related to the activation of mitochondrial ATP-sensitive potassium channels.
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Objective To investigate the effect of different doses of dexmedetomidine on myocardial injury (in perioperative peri‐od) on cardiopulmonary bypass (CPB) in patients with rheumatic heart valve replacement surgery .Methods Patients undertook rheumatic heart valve replacement surgery with mitral stenosis were divided into three groups (n=20) in randomized and double‐blind method :control group (group C) ,dexmedetomidine 0 .3 μg/kg group (DEX1 group) ,dexmedetomidine 0 .6 μg/kg group (DEX2 group) .Central venous blood was drawn respectively before anesthesia induction (T0 ) ,2h after CPB (T1 ) ,24 h after CPB (T2 ) ,48 h after CPB (T3 ) ,72 h after CPB (T4 ) .Plasma muscle calcium protein I (cTnI) and creatine kinase (CreatineKinase MB , CK‐MB) were measured and mean arterial pressure and heart rate were recorded at each time point .Furthermore ,extubation time , ICU stay ,postoperative inotropic score 24 h after operation ,drainage 24 h after operation ,cardio auto‐resuscitation rates and ad‐verse cardiovascular events were recorded .Results Compared with T0 ,HR was significantly lower in the T1 time point in DEX2 group .Compared with group C ,HR ,plasma CK‐MB ,inotropic score 24 h after operation and cardiovascular adverse events was sig‐nificantly reduced in the T1 time points in DEX1 group (P<0 .05) ,but the heart auto‐resuscitation rate did not significantly im‐proved .HR at T1 ,plasma CK‐MB values at T1 and T2 ,and plasma cTnI values at T2 -T4 were significantly reduced ;the heart re‐suscitation significantly increased ,myocardial contraction power ratings 24 h after operation and the incidence of cardiovascular e‐vents was significantly lower in DEX2 group (P<0 .05) .The extubation time ,ICU stay time and drainage 24 h after operation did not change significantly in both groups .Conclusion Dexmedetomidine has a protective effect on perioperative myocardial injury in patients with rheumatic heart valve replacement surgery ,and the effect would be better when the dexmedetomidine was infused at 0 .6 μg · kg -1 · h-1 after a loading dose of 0 .6 μg/Kg continuously .
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Objective To investigate the effects of β-blockers on cardiac protection and hemodynamic in patients with septic shock. Methods A prospective randomized controlled trial was conducted. Forty-one patients with septic shock in accordance with early goal directed treatment and met the target within 6 hours,and admitted to intensive care unit (ICU)of Affiliated Huxi Hospital of Jining Medical College from January 2012 to January 2014 were enrolled. The patients were divided into treatment group (n=21)and control group (n=20)by random number table. The patients in both groups were given the standard treatment,esmolol was giving to patients in treatment group in order to control the heart rate (HR)below 100 bpm within 2 hours,and the patients in control group only received standard treatment. The changes in hemodynamic parameters〔mean arterial pressure(MAP),central venous pressure(CVP), HR,cardiac index(CI),stroke volume index(SVI),systemic vascular resistance(SVRI),global end diastolic volume index(GEDVI)〕,biochemistry metabolic of tissue〔central venous oxygen saturation(ScvO2),lactic acid(Lac)〕,and cardiac markers 〔troponin I (cTnI)〕before and 12,24,48,72 hours after the treatment were recorded. Results①Before treatment,the hemodynamic parameters,tissue metabolism index and cTnI had no significant differences in both groups (all P>0.05).②The hemodynamic parameters after treatment in the control group showed no significant difference compared with that before treatment. HR and CI in the treatment group were gradually declined after treatment,SVRI and GEDVI were gradually increased. There were significant differences in HR,CI,SVRI,and GEDVI between treatment group and control group from 12 hours on〔HR(bpm):93±4 vs. 118±13,CI (L·min-1·m-2):3.3 ±0.8 vs. 4.5 ±0.6,SVRI (kPa·s·L-1·m-2):159.2 ±27.4 vs. 130.5 ±24.2,GEDVI(mL/m2):668 ±148 vs. 588 ±103,P0.05). The ScvO2 was not decreased in both groups.④Compared with before treatment,cTnI in the control group was gradually increased,peaked at 72 hours,and that in the treatment group was gradually increased,peaked at 24 hours and then gradually declined. Compared with control group,the cTnI (μg/L)in the treatment group was decreased significantly at 24,48,72 hours (1.15 ±0.57 vs. 1.74 ±0.77,0.93 ±0.52 vs. 2.15 ±1.23,0.52 ±0.36 vs. 2.39 ±1.17,all P<0.01). Conclusionsβ-blockers (esmolol) can improve cardiac function and myocardial compliance,reduce the myocardial injury in patients with sepsis shock. Although β-blockers can decrease cardiac output,it has no influence on the circulation function and tissue perfusion.
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Radiation therapy is one of the important systematic treatment strategies for breast cancer, but it also can cause a definite cardiac toxicity. Thus, the survival advantage of breast cancer patients receiving radiation therapy can even be offset by radiation-induced cardiac toxicity. Modern radiation therapy techniques have significantly decreased the incidence of RRHDs (radiation-related heart diseases). However, RRHDs have not been eliminated yet. This article introduces the pathology and pathophysiology and clinical sequelae of radiation-induced cardiac substructures toxicity, as well as synthetical protective strategies for cardiac substructures in the setting of modern radiation therapy techniques. Copyright © 2013 by TUMOR.
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To observe the protective e ect of oral Liuweidihuang pill combined with Shengmai capsule on heart of primary hypertension with syndrome of de ciency of both qi and yin of heart and kidney.Method:While decreasing blood pressure with Captopril,oral Liuweidihuang pill combined with Shengmai capsule was used to treat 55 cases of primary hypertension,control groups was established.BP,cardiac function,damage degree of myocardial hypertrophy and blood vessel endothelium were detected.Result:ALL the indexes above in treatment group decreased obviously,showed signi cant di erence when compared with control group.Conclusion:Oral Liuweidihuang pill combined with Shengmai capsule and Captopril has cooperative e ect of antihypertension.The combined medication can treat heart damage by reducing myocardial oxygen consumption index,reversing myocardial hypertrophy,improving left ventricular function,protecting blood vessel endothelium,and preventing arteriosclerosis.
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This paper presents the results of aortic and double valve replacement with tilting disc valves in 75 patients.Preoperafive diagnosis was rheumatic lesion in 48 cases, bacterial endocarditis in 22, congenital aortic stenosis in 3, and VSD with prolapse of aortic valve in 3.There were 9 early deaths with an overall operative mortality rate of 12%. During the follow-up of 7 months to 7 years and 11 months, there were 66 long-term survivals and 1 late death.The authors conclude that the early operation should be performed on patients with valve lesion or with combination of mitral valve lesions resulting in left ventricular impairment. The protection of the myocardium during operation is the most important procedure in reducing the operative mortality.