Yeşim BATİSLAM, Safinaz KARABAYIRLI, Tülay KORKMAZ, Oya ÖZATAMER

İskemik kalp hastalığı olan ve nonkardiyak elektif cerrahi planlanan hastalarda profilaktik beta-adrenerjik bloker ve nitrogliserin uygulamasının iskemi üzerine etkisi

Amaç: Holter ile tespit edilen perioperatif iskemi perioperatif kardiyak morbidite ve mortalite ile ilişkilidir. Nitratlar, kalsiyum kanal blokerleri, β blokerler ve α agonist ilaçlarla profi laktik tedavi önerilmektedir. Biz, koroner arter hastalığı olan nonkardiyak elektif cerrahi hastalarında perioperatif miyokardiyal iskemiyi önlemek için β bloker ve nitrogliserin uygulamalarını karşılaştırmayı amaçladık. Materyal ve Metod: Etik komite onayı alındıktan sonra bilgilendirilmiş koroner arter hastalığı olan 60 hasta randomize olarak üç gruba ayrıldı. Grup K'ya indüksiyondan önce plasebo olarak salin verildi. Grup BB'ye anesteziden önce 50 mg. oral yoldan ve 10 mg. yavaş injeksiyonla intravenöz olarak metoprolol verildi. Grup NTG'ye ise anesteziden önce 0,3 μg/kg/dk. nitrogliserin infüzyonu başlandı ve operasyon ve postoperatif 24 saat boyunca dozu 0,9-1 μg/kg/dk. ya yükseltilerek devam edildi. Hemodinamik veriler peroperatif kaydedildi.bütün hastalarda operasyondan önce ve postoperatif 8. ve 24. saatte CK-MB ve Troponin I düzeyleri ölçüldü. Perioperatif periyoddaki aritmiler ve ST-T segment değişiklikleri analiz edildi. 1 mV ve 1 dk.yı geçen ST değişiklikleri ST segment değişikliği olarak kabul edildi. Tüm hastalar preoperatif ve postoperatif 24 saat boyunca Holter ile monitörize edildi. Bulgular: Preoperatif dönemde hiçbir hastada ST-T segment değişikliği gözlenmedi. Grup K'da %50, Grup BB'de % 21,4 ve Grup NTG'de % 37,5 oranında ST-T segment değişikliği gözlenmesine rağmen hasta sayımız sınırlı olduğu için gruplar arasındaki fark istatiksel olarak anlamlı bulunmadı. Hiçbir hastada ciddi kardiyak komplikasyon olmadı. Sonuç: Koroner arter hastalığı olan nonkardiyak elektif cerrahi geçirecek hastalarda perioperatif β bloker uygulamasının yararlı olduğu sonucuna vardık.

The effect of prophylactic beta, blocker and nitroglycerine on perioperative myocardial aschemia in patients with coronary disease undergoing noncardiac elective surgery

Aim: Perioperative myocardial ischemia detected by Holter monitoring is associated with increased peroperative cardiac morbidity and mortality. Prophylactic therapy with nitrates, calcium-channel blockers agonist and β blockers drugs have been studied. We aimed to compare the administrations of β blocker to nitroglycerine with prevent perioperative myocardial ischemia for noncardiac elective surgical patients with coronary artery disease. Materials and Methods: After obtaining ethics committee approval and informed consent, sixty patients with coronary artery disease were randomly assigned into three groups. In group C(n=20) placebo was given before induction. In group BB(n=20) 50mg metoprolol SR was given orally and 10mg metoprolol was given by slow injection before anaesthesia. In group NTG(n=20) nitroglycerine 0.3 μg/kg/min infusion was given before anaesthesia and maintained by incremental doses of 0.9-1 μg/kg/min during the operation and postoperative 24 hours. Hemodynamic data was recorded during peroperative period. Levels of CK-MB and Troponin I of all patients were measured before the operation and at the 8th and 24th hours postoperatively. In the perioperative period, arrhythmias, changes of ST-T segment have been analyzed. ST changes over 1mV and lasting more than 1 minute has been accepted as a change of ST segment. All patients were monitored by Holter preoperatively and 24 hours postoperatively. Results: No patients displayed ST-T segment changes preoperatively. However, ratio of changes of ST-T segment were 50% in group C, 20% in group BB and 35% in group NTG perioperatively, however, statistical analysis did not show difference between the groups and this was attributed to the limited number of patients in groups. No patients had severe cardiac complication. Conclusion: Since we found that in metoprolol group, the incidence of perioperative myocardial ischemia was lower, we suggest that perioperative β blocker application in patients undergoing noncardiac elective surgery with coronary artery disease is beneficial.

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