无机硝酸盐对冠状动脉搭桥术后缺血再灌注损伤的影响

贵州医科大学      麻醉与心脏电生理课题组

翻译：牛振瑛   编辑：马艳燕   审校：曹莹

背景

一氧化氮(NO)是心血管系统中重要的信号分子，在缺血再灌注损伤中具有保护作用。无机硝酸盐是一种内源性NO生成的氧化产物，也是我们饮食中的一种成分，可以循环再利用为具有生物活性的NO。本实验研究了心脏手术患者术前服用无机硝酸盐是否可以减少肌钙蛋白T以及心脏、肝脏、肾脏和脑损伤的其他血浆标志物的释放。

方法

这项单中心、随机、双盲、安慰剂对照试验包括82名接受体外循环冠状动脉旁路手术的患者。患者术前口服硝酸钠(700 mg×2)或安慰剂(NaCl)。在手术前和手术后72小时收集缺血再灌注损伤的生物标志物、血浆硝酸盐和亚硝酸盐浓度。肌钙蛋白T的释放是我们预先定义的主要观察指标，肾、肝和脑损伤的生物标志物是次要指标。

结果

与安慰剂相比，硝酸盐治疗患者的血浆硝酸盐和亚硝酸盐浓度升高。肌钙蛋白T的72小时释放在不同组之间没有差异。器官损伤的其他血浆生物标志物在两组之间也是没有差异的。失血量不是一个预先定义的结果参数，但无机硝酸盐治疗的患者围手术期出血量比对照组减少了18%。

结论

术前给予无机硝酸盐并不影响肌钙蛋白T的释放或心脏手术中器官损伤的其他血浆生物标志物的释放。

原始文献来源：

Eriksson KE, et al.Effects of inorganic nitrate on ischaemia-reperfusion injury after coronary artery bypass surgery[J].Br J Anaesth. 2021 Oct;127(4):547-555

英文原文

Effects of inorganic nitrate on ischaemia-reperfusion injury after coronary artery bypass surgery

Background: Nitric oxide (NO) is an important signalling molecule in the cardiovascular system with protective properties in ischaemiaereperfusion injury. Inorganic nitrate, an oxidation product of endogenous NO production and a constituent in our diet, can be recycled back to bioactive NO. We investigated if preoperative administration of inorganic nitrate could reduce troponin T release and other plasma markers of injury to the heart, liver, kidney, and brain in patients undergoing cardiac surgery.

Methods: This single-centre, randomised, double-blind, placebo-controlled trial included 82 patients undergoing coronary artery bypass surgery with cardiopulmonary bypass. Oral sodium nitrate (700 mg?2) or placebo (NaCl) were administered before surgery. Biomarkers of ischaemiaereperfusion injury and plasma nitrate and nitrite were collected before and up to 72 h after surgery. Troponin T release was our predefined primary endpoint and biomarkers of renal, liver, and brain injury were secondary endpoints.

Results: Plasma concentrations of nitrate and nitrite were elevated in nitrate-treated patients compared with placebo.The 72-h release of troponin T did not differ between groups. Other plasma biomarkers of organ injury were also similar between groups. Blood loss was not a predefined outcome parameter, but perioperative bleeding was 18% less in nitrate-treated patients compared with controls.

Conclusion: Preoperative administration of inorganic nitrate did not influence troponin T release or other plasma bio-markers of organ injury in cardiac surgery.