Research Of Myocardial Protection With Perioperative Infusion Diltiazem In Patients Undergoing Off-pump Coronary Artery Bypass Graft

Objective This prospective clinical study is to evaluate the effects of calcium channel blocker---diltiazem on perioperative myocardial protection, prophylactic arrhythmia, and myocardial function with the patients undergoing off-pump coronary artery bypass grafting(OPCAB).Method 100 patients undergoing elected OPCAB receive a continuous 24-hour perioperative infusion of either diltiazem 1.0-5.0ug/Kg.min in group D (n=50), or nitroglycerin 1.0-5.0ug/Kg.min in group N (n=50) on the randomized study consecutively. Perioperative monitoring includes 24-hour 9-lead electrocardiogram, heart rat(eHR), blood pressur(eBP), and other hemodynamic measurements of mean pulmonary artery pressure(MPAP), pulmonary capillary wedge pressure(PCWP), mixed venous oxygen saturation(MVOS), cardiac index(CI), systemic vascular resistance(SVR), pulmonary vascular resistance(PVR). Patients are detected myocardial ischemia and arrhythmias by 12-lead electrocardiogram on each time-record. The analysis of ischemia–special laboratory parameter creatine kinase-MB(CK-MB) and cardiac Troponin I(cTnI)are determined during time-reccord 48-hour postoperative. The data of perioperative and measurements are analysed in statistics.Result The two groups do not differ with respect to preoperative and operative data. The significant difference in HR ,mean blood pressure, HRxSAP, SVR, MVOS, and CK-MB,cTnI between the two group are detected, and D group is significant lower expect the MVOS during each time-record postoperative. The incidence of transient ischemia events(12% vs 26%), atrial fibrillation (AF)(10% vs 22%),and ventricular arrhythmia (12% vs 26%) are significant low in diltiazem group. No significant difference data of CI, atrioventricular block, intubation duration (14.8±5.6h vs 15.1±6.7h) and intensive care unit duration(21.1±10.1h vs 21.8±9.4h)is detected between two groups.Conclusion Perioperative infusion diltiazem has effect on reducing myocardial ischemia and arrhythmia in patients undergoing off-pump coronary artery bypass graft. It provides a stable hemodynamics. It has no adverse effect on systolic myocardial function and myocardial conduction.