Effect of nicorandil on early prognosis in patients undergoing cardiac valve replacement with cardiopulmonary bypass / 中华麻醉学杂志

ABSTRACT

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.