Clinical Outcomes of Papaverine Perfusion under Cardiopulmonary Bypass in Coronary Artery Bypass Grafting_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

 ZHAOTie-fu , WANGSheng-yu , CHENHong , ZHANGChun-xiao

Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, P. R. China;

Corresponding?author：

ZHAOTie-fu, Email: tiefuzhao@163.com

Keywords：

Coronary artery bypass grafting; Cardiopulmonary bypass; Myocardial protection; Papaverine

DOI：

10.7507/1007-4848.20160271

Video：

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Objective To explore clinical outcomes of papaverine via the aortic root under cardiopulmonary bypass (CPB) in coronary artery bypass grafting. Methods A total of 263 patients with coronary artery disease underwent CPB in coronary artery bypass grafting in Beijing Anzhen Hospital from August 2003 through December 2014 were included. According to whether or not they received papaverine perfusion via the aortic root in the first perfusion during CPB, all the 263 patients were divided into two groups including an intervention group and a control group. There were 176 patients in the intervention group including 109 males and 67 females with their average age of 64.37±23.54 years. They received aortic root perfusion of 60 mg papaverine diluted into 20 ml during the first perfusion, and repeated aspiration was performed 8 to 10 times in CPB when the heart beat weak. In the control group, there were 87 patients including 55 males and 32 females with their average age of 65.98±29.13 years. Patients in the control group received routine procedures of CPB except papaerine perfusion. Clinical effectiveness was compared between the two groups. Results There was no in-hospital death. CPB supporting time after heart re-beating (9.58±3.21 min vs. 19.74±5.67 min, t=-1.133, P=0.000), dopamine usage 3.12±1.27 μg/(kg·min) vs. 4.98±2.53 μg/(kg·min),t=-0.913, P=0.031), epinephrine usage 0.018±0.009 μg/(kg·min) vs. 0.047±0.011 μg/(kg·min), t=-0.811, P=0.018) and nor epinephrine usage 0.021±0.011 μg/(kg·min) vs. 0.037±0.010 μg/(kg·min), t=-0.823, P=0.019) of the intervention group were significantly shorter or lower than those of the control group. Automatic heart re-beating rate of the intervention group was significantly higher than that of the control group (98.86% vs. 70.11%,t=-1.372, P=0.000). A total of 176 patients in the nitroglycerin group were followed up for 6-121 months, and 16 patients were lost during follow-up. During the follow-up period, 6 patients were hospitalized for cardiac events, and 2 died in 29 months and 103 months after surgery, and 9 died from cardiac events. Conclusion For the patients undergoing on-pump coronary artery bypass grafting, some myocardial protection strategies including papaverine perfusion via the aortic root in the first perfusion, use of norepinephrine, and aortic root squeezing in high frequency by hand can significantly increase the automatic heart re-beating rate, shorten the CPB supporting time after heart re-beating, and improve postoperative clinical outcomes.

Citation： ZHAOTie-fu, WANGSheng-yu, CHENHong, ZHANGChun-xiao. Clinical Outcomes of Papaverine Perfusion under Cardiopulmonary Bypass in Coronary Artery Bypass Grafting. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2016, 23(12): 1150-1153. doi: 10.7507/1007-4848.20160271 Copy

1.	穆軍升, 周帆, 張健群, 等. 80歲以上老年患者冠狀動脈旁路移植術65例臨床分析. 中國胸心血管外科臨床雜志, 2011, 18(5): 464-465.
2.	柏本健, 魏維強, 解洪濤, 等. 體外循環和非體外循環冠狀動脈旁路移植術的早期療效比較. 中國胸心血管外科臨床雜志, 2010, 17(3): 244-246.
3.	楊業超, 許建屏. 影響冠狀動脈旁路移植術加心瓣膜手術患者遠期預后的危險因素分析. 中國胸心血管外科臨床雜志, 2011, 18(1): 88-89.
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5.	劉洪端, 劉立明. 缺血后處理的研究進展. 中國胸心血管外科臨床雜志, 2012, 19(3): 309-313.
6.	陳林, 肖穎彬, 肖娟, 等. 不同心肌保護方法在雙瓣膜置換術中對心肌的保護作用. 中國胸心血管外科臨床雜志, 2012, 19(4): 371-375.
7.	沈劉忠, 陳緒軍, 陳鑫, 等. 老年冠狀動脈粥樣硬化性心臟病患者橈動脈抗痙攣藥物選擇的實驗研究. 中華外科雜志, 2010, 48(19): 1488-1491.
8.	Braunwald E, Antman EM, Beasley JW, et al. ACC/AHA 2002 guide-line update for he management of patients with unstable angina and non-ST-segmentelevation myocardial infarction--summary article：a report of the American College of Cardiology/American Heart Association task force on practice guidelines(Committee on the Management of Patients With Unstable Angina). J Am Coll Cardiol, 2002, 40(7): 1366-1374.
9.	姜大慶, 谷天祥, 王海龍, 等. 老年患者非體外和體外循環冠狀動脈旁路移植術圍術期腦卒中發生率比較的系統評價和Meta分析. 中國胸心血管外科臨床雜志, 2011, 18(4): 289-300.
10.	程兆云, 趙子牛, 權曉強, 等. 體外與非體外循環冠狀動脈旁路移植術698例. 中國胸心血管外科臨床雜志, 2009, 16(6): 430-434.
11.	喻磊, 谷天祥, 師恩祎, 等. 70歲以下多支冠狀動脈病變患者體外與非體外循環冠狀動脈旁路移植術的比較.中國胸心血管外科臨床雜志, 2010, 17(4): 292-296.
12.	楊磊. 腦鈉肽的生物學意義與臨床價值. 臨床合理用藥雜志, 2010, 3(3): 125-126.
13.	解少強, 吳遠林, 楊朝坤, 等. 心臟瓣膜病外科治療267例. 中國胸心血管外科臨床雜志, 2012, 19(1): 105.
14.	王輝山, 汪曾煒, 朱洪玉, 等. 老年患者二尖瓣置換同期行冠狀動脈旁路移植術的臨床分析. 中國胸心血管外科臨床雜志, 2008, 15(3): 222-224.
15.	Hall RI, Smith MS, Rocker G. The systemic inflammatory response to cardiopulmonary bypass：pathophysiological, therapeutic, and pharmacological considerations. Anesth Analg, 1997, 85(4): 766-782.
16.	權曉強, 程兆云, 孫俊杰, 等.并行體外循環下不停跳冠狀動脈旁路移植術在冠狀動脈左主干病變中的應用價值. 中華醫學雜志, 2013, 93(32): 2545-2548.
17.	張梅, 張運, 李貴雙, 等. 經皮冠狀動脈內多普勒超聲技術對冠狀動脈血液動力學的研究. 中國循環雜志, 2000, 15(4): 216-217.
18.	楊柏松, 齊國先, 楊滿光, 等. 冠狀動脈造影正常的胸痛患者冠狀動脈血流儲備功能研究. 臨床心血管病雜志, 2003, 19(5): 270-272.
19.	王妍軍. 罌粟堿和硝酸甘油對乳內動脈血流量和血管內膜影響的對比研究. 首都醫科大學, 2006.
20.	王盛宇, 趙鐵夫, 王嶸, 等.心瓣膜置換術中心臟復跳前主動脈根部灌注硝酸甘油的療效分析.中國胸心血管外科臨床雜志, 2013, 20(1): 29-32.

1. 穆軍升, 周帆, 張健群, 等. 80歲以上老年患者冠狀動脈旁路移植術65例臨床分析. 中國胸心血管外科臨床雜志, 2011, 18(5): 464-465.
2. 柏本健, 魏維強, 解洪濤, 等. 體外循環和非體外循環冠狀動脈旁路移植術的早期療效比較. 中國胸心血管外科臨床雜志, 2010, 17(3): 244-246.
3. 楊業超, 許建屏. 影響冠狀動脈旁路移植術加心瓣膜手術患者遠期預后的危險因素分析. 中國胸心血管外科臨床雜志, 2011, 18(1): 88-89.
4. 李佳春, 李功宋, 主編. 體外循環灌注學. 北京: 人民軍醫出版社, 1993. 107.
5. 劉洪端, 劉立明. 缺血后處理的研究進展. 中國胸心血管外科臨床雜志, 2012, 19(3): 309-313.
6. 陳林, 肖穎彬, 肖娟, 等. 不同心肌保護方法在雙瓣膜置換術中對心肌的保護作用. 中國胸心血管外科臨床雜志, 2012, 19(4): 371-375.
7. 沈劉忠, 陳緒軍, 陳鑫, 等. 老年冠狀動脈粥樣硬化性心臟病患者橈動脈抗痙攣藥物選擇的實驗研究. 中華外科雜志, 2010, 48(19): 1488-1491.
8. Braunwald E, Antman EM, Beasley JW, et al. ACC/AHA 2002 guide-line update for he management of patients with unstable angina and non-ST-segmentelevation myocardial infarction--summary article：a report of the American College of Cardiology/American Heart Association task force on practice guidelines(Committee on the Management of Patients With Unstable Angina). J Am Coll Cardiol, 2002, 40(7): 1366-1374.
9. 姜大慶, 谷天祥, 王海龍, 等. 老年患者非體外和體外循環冠狀動脈旁路移植術圍術期腦卒中發生率比較的系統評價和Meta分析. 中國胸心血管外科臨床雜志, 2011, 18(4): 289-300.
10. 程兆云, 趙子牛, 權曉強, 等. 體外與非體外循環冠狀動脈旁路移植術698例. 中國胸心血管外科臨床雜志, 2009, 16(6): 430-434.
11. 喻磊, 谷天祥, 師恩祎, 等. 70歲以下多支冠狀動脈病變患者體外與非體外循環冠狀動脈旁路移植術的比較.中國胸心血管外科臨床雜志, 2010, 17(4): 292-296.
12. 楊磊. 腦鈉肽的生物學意義與臨床價值. 臨床合理用藥雜志, 2010, 3(3): 125-126.
13. 解少強, 吳遠林, 楊朝坤, 等. 心臟瓣膜病外科治療267例. 中國胸心血管外科臨床雜志, 2012, 19(1): 105.
14. 王輝山, 汪曾煒, 朱洪玉, 等. 老年患者二尖瓣置換同期行冠狀動脈旁路移植術的臨床分析. 中國胸心血管外科臨床雜志, 2008, 15(3): 222-224.
15. Hall RI, Smith MS, Rocker G. The systemic inflammatory response to cardiopulmonary bypass：pathophysiological, therapeutic, and pharmacological considerations. Anesth Analg, 1997, 85(4): 766-782.
16. 權曉強, 程兆云, 孫俊杰, 等.并行體外循環下不停跳冠狀動脈旁路移植術在冠狀動脈左主干病變中的應用價值. 中華醫學雜志, 2013, 93(32): 2545-2548.
17. 張梅, 張運, 李貴雙, 等. 經皮冠狀動脈內多普勒超聲技術對冠狀動脈血液動力學的研究. 中國循環雜志, 2000, 15(4): 216-217.
18. 楊柏松, 齊國先, 楊滿光, 等. 冠狀動脈造影正常的胸痛患者冠狀動脈血流儲備功能研究. 臨床心血管病雜志, 2003, 19(5): 270-272.
19. 王妍軍. 罌粟堿和硝酸甘油對乳內動脈血流量和血管內膜影響的對比研究. 首都醫科大學, 2006.
20. 王盛宇, 趙鐵夫, 王嶸, 等.心瓣膜置換術中心臟復跳前主動脈根部灌注硝酸甘油的療效分析.中國胸心血管外科臨床雜志, 2013, 20(1): 29-32.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Clinical Outcomes of Papaverine Perfusion under Cardiopulmonary Bypass in Coronary Artery Bypass Grafting

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