Effect of trimetazidine and glucose- insulin-potassium use on myocard during beating heart coronary artery bypass surgery

Yıl 2011, Cilt: 38 Sayı: 4, 436 - 444, 01.12.2011

Abdulkadir Ercan Yusuf Velioğlu Arzu Ercan Orçun Gürbüz Hakan Özkan İlker Hasan Karal Murat Biçer Serdar Ener

https://doi.org/10.5798/diclemedj.0921.2011.04.0063

Öz

Objectives: This prospective, randomised, controlled, clinical study was planned to determine the effect of trimetazidine and glucose - insulin - potassium (GIK) on myocardial ischemia-rep­erfusion during beating heart coronary artery bypass surgery. Materials and methods: Patients (n=45) with coronary artery disease who required beating heart coronary artery bypass grafting were randomly allocated into three groups. Patients in group 1 (n=15) was recevied trimetazidine (20 mg x 3 per day) 7 days before surgery. Patients in group 2 (n=15) received GIK infusion after induction of anesthesia through the first 12 hours of intensive care unit convalescence. Patients in group 3 (n=15) were control group. Measurements of blood glucose, circulating creatine kinase MB (CK-MB) and Troponin I (TnI) concentra­tions were obtained before surgery, 5 minutes after completion of operation and at 12, 24, and 48 hours postoperatively. Mean pulmonary artery pressure, cardiac index, morbidity and data associated with operation were recorded in all patients preop­eratively and postoperatively. Results: Preoperative risk profiles and operative variables were statistically similar when the groups were compared. The concentration of circulating CK-MB and Tn I significantly in­creased over time after off - pump coronary artery surgery, with no significant intergroup differences. Cardiac index and mean pulmonary artery pressure did not differ significantly between groups. Conclusion: Pretreatment with trimetazidine and GIK infusion protocol were used as an adjunct to ischemic - reperfusion therapy in off - pump coronary artery bypass surgery. These results suggested that pretreatment with trimetazidine and GIK infusion protocol do not significantly reduce ischemic reperfu­sion damage.

Anahtar Kelimeler

Trimetazidine, glucose - insulin - potassium, myo­cardial protection, off-pump coronary artery bypass

Çalışan kalpte koroner baypas cerrahisi sırasında trimetazidine ve glikoz-insülin-potasyum kullanımının miyokard üzerine etkileri

Öz

Amaç: Çalışan kalpte koroner baypas esnasında trimetazi­dine ve glikoz - insülin - potasyum (GİK) solüsyonunun miyo­kardiyal iskemi ve reperfüzyon hasarı üzerine etkilerini araş­tırmak üzere ileri dönük, randomize, kontrollü klinik çalışma planlandı. Gereç ve yöntem: Çalışan kalpte koroner cerrahisi yapılacak toplam 45 koroner arter hastası randomize olarak üç gruba ayrıldı. Grup 1 (n=15) hastalar cerrahi öncesi 7 günlük süreyle bir tablet (trimetazidine 20 mg) günde 3 kez olarak aldı. Grup 2 (n=15) hastalar anestezi indüksiyonu sonrası ilk 12 saat bo­yunca intravenöz glukoz-insülin-potasyum (GİK) solüsyonunu aldı. Grup 3 (n=15) hastalar kontrol grubu olarak değerlendi­rildi. Tüm hastalarda kan glikozu, kreatin kinaz MB (CK-MB), Troponin I (Tn I) ölçümleri cerrahi öncesi, postoperatif 5. da­kikada, 12. saatte, 24. saatte, ve 48. saatte yapıldı. Ortala­ma pulmoner arter basıncı ve kardiyak indeks, ameliyata ait veriler ve morbidite tüm hastalarda preoperatif ve postoperatif dönemlerde kaydedildi. Bulgular: Preoperatif risk profilleri ve operatif değişken­ler karşılaştırıldığında her iki grup arasında fark yoktu. Tn I ve CK-MB değerleri koroner baypas sonrası anlamlı olarak yükseldi ancak gruplar arasında anlamlı fark yoktu. Kardiyak indeks ve ortalama pulmoner arter basıncı gruplar arasında anlamlı farklılık göstermiyordu. Sonuç: Trimetazidine ile ameliyat öncesi tedavi ve GİK in­füzyon protokolü çalışan kalpte koroner baypas cerrahisinde iskemi-reperfüzyon hasarının azaltılması amacıyla kullanıl­maktadır. Bu çalışma sonuçları trimetazidine ve GİK infüzyon protokolünün iskemi-reperfüzyon hasarı üzerine önemli etkisi olmadığını gösterdi.

Anahtar Kelimeler

Trimetazidine, glikoz - insülin - potasyum, miyokardiyal koruma, çalışan kalpte koroner baypas

Kaynakça

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