The Myocardial Protection Of Lactate Shuttle Excitting Effect From Trimetazidine For Elderly Coronary Artery Disease Patients Who Need To Receive Non-cardiac Surgeries

Objective: By observing the myocardial protection of lactate shuttle excitting effect from trimetazidine, to search a new therapeutic target and a simple and practicable perioperative myocardial protection strategy for elderly coronary artery disease patients who need to receive non-cardiac surgeries.Methods: This is a single center, prospective, randomized clinical trial. sixty patients with CAD undergoing elective surgery were randomly divided into trimetazidine group(group T, n = 30) and control group(group C, n = 30). In group T, the patients were given 60 mg trimetazidine one time by mouth thirty minutes before anesthesia inducing. The patients in two groups were all given with combined intravenous-inhalation anesthesia. Respectively, the LDH,c Tn I and Lac were tested at the time points before anesthesia, immediate postoperative,24 hours and 48 hours after surgery. By recording the 12-lead ECG ST-T changes and arrhythmia in perioperative period to observe the occurrence of myocardial ischemia and compared with status before operation.Recording the incidences of the adverse cardiac events of the patients in two groups during thirty days after surgery.Results: The level of c Tn I,LDH and Lac of the patients in two groups were all increased after surgery, but the increasing values of the patients in group C were higher than group T(P<0.05), which had the statistical significance;Compared with the occurrence of the myocardial ischemia(include the ST-T changes and arrhythmia)and adverse cardiac events of the patients in twogroups during perioperative period and thirty days after surgery. The incidence of the patients in group T was lower than those in group C, but the incidence of cardiovascular adverse events only during perioperative period was significant difference(P<0.05)between two groups; As for the incidence during thirty days after surgery, there was no statistical significance.Conclusions: Trimetazidine has lactate shuttle excitting effect. The preload of trimetazidine can promote cardiac muscle to take good use of lactate, relieve the heart damage from surgery,anesthesia and perioperative relevant stimuli,reduce the incidences of perioperative myocardial adverse events,and has myocardial protection effect for the ederly patients with coronary artery disease who need to receive non-cardiac surgery.