心脏风险高的患者在血管手术期间使用磷酸肌酸心脏保护剂的有效性

I. Kozlov, D. A. Sokolov, P. A. Lyuboshevsky
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The occurrence of CVC, the blood level of the cardiospecific troponin I (cTnI) and N-terminal segment of natriuretic B-type prohormone (NT-proBNP) were analyzed. The data were statistically processed, using the Fisher’s exact test, Mann–Whitney test and logistic regression.Results. Perioperative CVС were recorded in 5 (4.9%) patients in group I and in 18 (17.6%) patients in group II (p = 0.007). Intraoperative administration of phosphocreatine was associated with a reduced risk of CVС: OR 0.2405, 95% CI 0.0856–0.6758, p = 0.007. The cTnI level in patients of groups I and II was 0.021 [0.016–0.030] and 0.019 [0.011–0.028] ng/ml (p = 0.102) before surgery, 0.025 [0.020–0.036] and 0.022 [0.015–0.039] ng/ml (p = 0.357) after surgery, 0.025 [0.020–0.031] and 0.028 [0.018–0.033] ng/ml (p = 0.531) before discharge from the hospital. At the same stages, the level of NT-proBNP was 233.5 [195.0–297.5] and 237.8 [171.3–310.1] pg/ml (p = 0.404), 295.5 [257.3–388.0] and 289.0 [217.5–409.5] pg/ml (p = 0.226), 265.5 [204.8–348.5] and 259.6 [171.0–421.6] pg/ml (p = 0.369).Conclusion. In patients with high cardiac risk undergoing vascular surgery, intraoperative phosphocreatine infusion at a total dose of 75.9 [69.8–85.7] mg/kg reduces the risk of perioperative CVC per 24%. 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The study involved 204 patients with high cardiac risk (revised cardiac risk index > 2, risk of perioperative myocardial infarction or cardiac arrest > 1%) who underwent elective vascular surgery. The patients were randomly divided into two groups. Group I patients received intraoperative infusion of phosphocreatine at a dose of 75.9 [69.8–85.7] mg/kg during 120.0 [107.1–132.0] min. Group II was a control group. The occurrence of CVC, the blood level of the cardiospecific troponin I (cTnI) and N-terminal segment of natriuretic B-type prohormone (NT-proBNP) were analyzed. The data were statistically processed, using the Fisher’s exact test, Mann–Whitney test and logistic regression.Results. Perioperative CVС were recorded in 5 (4.9%) patients in group I and in 18 (17.6%) patients in group II (p = 0.007). Intraoperative administration of phosphocreatine was associated with a reduced risk of CVС: OR 0.2405, 95% CI 0.0856–0.6758, p = 0.007. 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引用次数: 0

摘要

目的是研究在血管手术术中输注磷酸肌酸的患者围术期心血管并发症(CVС)的发生率以及临床和实验室心血管保护征象。研究涉及 204 名接受择期血管手术的高心脏风险患者(修正心脏风险指数大于 2,围术期心肌梗死或心脏骤停风险大于 1%)。患者被随机分为两组。I 组患者在术中输注磷酸肌酸,剂量为 75.9 [69.8-85.7] mg/kg,时间为 120.0 [107.1-132.0] 分钟。第二组为对照组。分析了CVC的发生率、血液中心肌特异性肌钙蛋白I(cTnI)和降钠B型前体(NT-proBNP)的N末端水平。采用费雪精确检验、曼-惠特尼检验和逻辑回归对数据进行了统计处理。第一组和第二组分别有 5 名(4.9%)和 18 名(17.6%)患者在围手术期出现 CVС(P = 0.007)。术中使用磷酸肌酸可降低 CVС 的风险:OR 0.2405,95% CI 0.0856-0.6758,p = 0.007。I 组和 II 组患者术前 cTnI 水平分别为 0.021 [0.016-0.030] 和 0.019 [0.011-0.028] ng/ml(p = 0.102),术后分别为 0.025 [0.020-0.036] 和 0.022[0.015-0.039]纳克/毫升(P = 0.357),出院前分别为0.025[0.020-0.031]和0.028[0.018-0.033]纳克/毫升(P = 0.531)。在同一阶段,NT-proBNP 的水平分别为 233.5 [195.0-297.5] 和 237.8 [171.3-310.1] pg/ml(p = 0.404)、295.5 [257.3-388.0] 和 289.0 [217.5-409.5] pg/ml(P = 0.226),265.5 [204.8-348.5] 和 259.6 [171.0-421.6] pg/ml(P = 0.369)。对于接受血管手术的高心脏风险患者,术中输注总剂量为 75.9 [69.8-85.7] mg/kg 的磷酸肌酸可将围手术期 CVC 的风险降低 24%。在血管手术期间为心脏风险高的患者输注磷肌酸不会影响围手术期 cTnI 和 NT-proBNP 血液水平。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
The effectiveness of phosphocreatine cardioprotection during vascular surgery in high cardiac risk patients
The objective was to study the occurrence of perioperative cardiovascular complications (CVС) and clinical and laboratory cardioprotection signs in patients treated with phosphocreatine infusion in intraoperative period of vascular surgery.Materials and methods. The study involved 204 patients with high cardiac risk (revised cardiac risk index > 2, risk of perioperative myocardial infarction or cardiac arrest > 1%) who underwent elective vascular surgery. The patients were randomly divided into two groups. Group I patients received intraoperative infusion of phosphocreatine at a dose of 75.9 [69.8–85.7] mg/kg during 120.0 [107.1–132.0] min. Group II was a control group. The occurrence of CVC, the blood level of the cardiospecific troponin I (cTnI) and N-terminal segment of natriuretic B-type prohormone (NT-proBNP) were analyzed. The data were statistically processed, using the Fisher’s exact test, Mann–Whitney test and logistic regression.Results. Perioperative CVС were recorded in 5 (4.9%) patients in group I and in 18 (17.6%) patients in group II (p = 0.007). Intraoperative administration of phosphocreatine was associated with a reduced risk of CVС: OR 0.2405, 95% CI 0.0856–0.6758, p = 0.007. The cTnI level in patients of groups I and II was 0.021 [0.016–0.030] and 0.019 [0.011–0.028] ng/ml (p = 0.102) before surgery, 0.025 [0.020–0.036] and 0.022 [0.015–0.039] ng/ml (p = 0.357) after surgery, 0.025 [0.020–0.031] and 0.028 [0.018–0.033] ng/ml (p = 0.531) before discharge from the hospital. At the same stages, the level of NT-proBNP was 233.5 [195.0–297.5] and 237.8 [171.3–310.1] pg/ml (p = 0.404), 295.5 [257.3–388.0] and 289.0 [217.5–409.5] pg/ml (p = 0.226), 265.5 [204.8–348.5] and 259.6 [171.0–421.6] pg/ml (p = 0.369).Conclusion. In patients with high cardiac risk undergoing vascular surgery, intraoperative phosphocreatine infusion at a total dose of 75.9 [69.8–85.7] mg/kg reduces the risk of perioperative CVC per 24%. Administration of phosphocreatine to patients with high cardiac risk during vascular surgery does not affect perioperative cTnI and NT-proBNP blood levels.
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