Zusammenfassung
Hintergrund
Ziel dieser Studie war es die kombinierte Gabe des β-Blockers Esmolol und des Phosphodiesterase-(PDE)-III-Hemmstoffs Enoximon hinsichtlich ihrer Wirkungen auf die kardiale Funktion bei gefäßchirurgischen Patienten mit manifester koronarer Herzkrankheit zu prüfen.
Patienten und Methoden
Für einen Zeitraum von 24 h erhielten 28 Patienten zusätzlich zu einer herzfrequenzgesteuerten β-Blockade mit Esmolol den PDE-III-Hemmer Enoximon (Esmolol+Enoximon-Gruppe) oder nur Esmolol (Esmolol-Gruppe). Die kardiale Funktion wurde mithilfe des Pulmonalarterienkatheters sowie der biochemischen Marker Troponin T (TnT) und „B-type natriuretic peptide“ (BNP) evaluiert.
Ergebnisse
Die Herzfrequenz lag in beiden Gruppen über den Beobachtungszeitraum im angestrebten Bereich von 50–60 min−1. Der „cardiac index“ der Patienten in der Esmolol+Enoximon-Gruppe stieg signifikant gegenüber dem Ausgangswert an und lag signifikant höher als in der Esmolol-Gruppe (Esmolol+Enoximon: von 2,4±0,2 l×min−1×m−2 auf 3,2±0,2 l×min−1×m−2; Esmolol von 2,5±0,2 l×min−1×m−2 auf 2,4±0,2 l×min−1×m−2). Bei keinem Patienten kam es zu signifikant erhöhten TnT-Werten. Die BNP-Werte stiegen in beiden Gruppen signifikant an; hierbei wurden in der Esmolol-Gruppe die höchsten BNP-Werte gemessen.
Schlussfolgerung
Bei gefäßchirurgischen kardialen Risikopatienten konnte durch eine positiv-inotrope Therapie mit dem selektiven PDE-III-Hemmer Enoximon eine Verbesserung der kardialen Funktion auch im Rahmen einer herzfrequenzgesteuerten kontinuierlichen β-Blockade mit Esmolol erreicht werden.
Abstract
Background
The aim of this study was to assess cardiac function in vascular surgery patients with known coronary artery disease (CAD) who received continuous perioperative beta blocker therapy with esmolol alone versus esmolol in combination with the phosphodiesterase (PDE) III inhibitor enoximone.
Patients and methods
Over a period of 24 h, 28 patients were assigned to receive heart rate (HR) control by continuous infusion of esmolol in combination with the PDE III inhibitor enoximone (Esmolol+Enoximone group) or esmolol alone (Esmolol group; n=14). Cardiac function was assessed by the use of a pulmonary artery catheter and serial measurements of plasma troponin T (TnT) und B-type natriuretic peptide (BNP).
Results
The heart rate significantly decreased to the target rate of 50–60 min−1 in both groups over the observation period. Cardiac index increased significantly only in Esmolol+Enoximone-treated patients (from 2.4±0.2 l×min−1×m−2 to 3.1±0.1 l×min−1×m−2) and was significantly higher than in the esmolol alone group (from 2.5±0.2 l×min−1×m−2 to 2.4±0.1 l×min−1×m−2). No patient had detectable levels of cTnT perioperatively. Peak plasma BNP concentrations were significantly increased in both groups but the highest values were measured in the esmolol alone group.
Conclusion
Inotropic therapy with the PDE III inhibitor enoximone improves cardiac function in high risk patients with known CAD undergoing vascular surgery and also when receiving systematic heart rate control by continuous infusion of esmolol.
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Suttner, S., Boldt, J., Lang, K. et al. Kontinuierliche β-Blockade mit Esmolol in Kombination mit Enoximon-Gabe. Anaesthesist 57, 231–241 (2008). https://doi.org/10.1007/s00101-008-1313-2
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DOI: https://doi.org/10.1007/s00101-008-1313-2