RESUMO
Objective:To evaluate the effect of nicorandil on cardiac function in the patients undergoing cardiac valve replacement under cardiopulmonary bypass (CPB).Methods:Forty patients of both sexes, aged 18-64 yr, of American Society of Anesthesiologists physical status Ⅱ-Ⅳ, with New York Heart Association class Ⅱ or Ⅲ, with body mass index of 18-25 kg/m 2, scheduled for elective cardiac valve replacement under general anesthesia and CPB, were divided into conventional group( n=20) and nicorandil group( n=20) according to a randomized number table method.In nicorandil group, nicorandil 10-60 μg·kg -1·h -1 was intravenously infused starting from the end of anesthesia induction until the the end of operation.Mean arterial pressure was maintained at 60-80 mmHg in two groups.Venous blood samples were collected before induction of anesthesia (T 0) and at 6, 12, 24, 48 and 72 h after operation (T 1-5) and at the time of discharge (T 6) to determine the serum amino-terminal pro-brain natriuretic peptide (NT-proBNP) concentrations.The occurrence of myocardial ischemic events or arrhythmia before and after operation was recorded.The defibrillation during intraoperative restoration of spontaneous heart beat, restoration of spontaneous heart beat, medication during restoration of spontaneous heart beat, and cardiac rhythm after restoration of spontaneous heart beat were recorded.The intra- and post-operative requirements for cardiovascular drugs were recorded.The mechanical ventilation time and intensive care unit stay time were also recorded. Results:Compared with conventional group, the serum NT-proBNP concentration was significantly decreased at T 5 and T 6, the mechanical ventilation time and intensive care unit stay time were shortened, the consumption of intraoperative norepinephrine and postoperative dobutamine was decreased ( P<0.05), and no significant change was found in the incidence of postoperative myocardial ischemic events or arrhythmias, defibrillation rate during restoration of spontaneous heart beat, rate of spontaneous recovery of heart beat, cardiac rhythm after restoration of spontaneous heart beat or medication during restoration of spontaneous heart beat in nicorandil group ( P>0.05). Conclusion:Intravenous infusion of nicorandil can improve the cardiac function and is helpful in improving short-term prognosis in the patients undergoing cardiac valve replacement under CPB.
RESUMO
Objective To evaluate the effect of nicorandil on early prognosis in patients undergoing cardiac valve replacement with cardiopulmonary bypass (CPB).Methods Forty American Society of Anesthesiologists physical status Ⅱ or Ⅳ patients,aged 18-64 yr,with New York Heart Association grade Ⅱ or Ⅲ,scheduled for elective cardiac valve replacement with CPB,were divided into 2 groups (n =20 each) using a random number table method:control group and nicorandil group.Nicorandil was intravenously infused at 10-60 μg · kg-1 · h-1 (3-15 ml/h) after anesthesia induction until the end of surgery in nicorandil group.Before anesthesia induction (To) and at 6,12,24,48 and 72 h after surgery (T1-5),and when the patients were discharged from hospital (T6),venous blood samples were obtained for determination of the concentrations of serum cardiac troponin I (cTnI) and brain natriuretic peptide.The events of myocardial ischemia or development of arrhythmia before and after surgery,development of defibrillation during restoration of heart beat,spontaneous heart beat,drug administration during restoration of heart beat,heart rhythm after restoration of heart beat,and the requirement for cardiovascular drugs during and after surgery were recorded.The mechanical ventilation time,duration of intensive care unit stay,and length of postoperative hospital stay were also recorded.Results Compared with control group,the concentrations of serum cTnI at T2,3 and brain natriuretic peptide at T2-6 were significantly decreased,the consumption of intraoperative norepinephrine and postoperative dobutamine was reduced,and the ventilation time and duration of intensive care unit stay were shortened (P＜0.05),and no significant change was found in the rate of defibrillation,restoration of spontaneous heart beat,requirement for drugs during restoration,heart rhythm after restoration or duration of postoperative hospital stay in nicorandil group (P ＞ 0.05).Conclusion Continuously infusing nicorandil during surgery can reduce myocardial injury and improve early prognosis in patients undergoing cardiac valve replacement with CPB.