RU2467754C2 - Method for prevention of heart rhythm disorder in cardiac surgeries - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely anaesthesiology and resuscitation, and concerns prevention of heart rhythm disorder in cardiac surgeries with the use of an cardiopulmonary bypass. That is ensured by the introduction of 25% magnesium sulphate 0.05-0.07 mmole/kg of patient's body weight before connection to the cardiopulmonary bypass and 0.05-0.07 mmole/kg before reperfusion through a special medicinal port.

EFFECT: dose schedule of the preparation enables cardiac stabilisation and prevented heart rhythm disorder during cardiac surgery.

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Description

The invention relates to medicine, namely to anesthesiology-resuscitation, and can be used to prevent cardiac arrhythmias during cardiosurgical operations using a cardiopulmonary bypass.

There is a method of preventing heart rhythm disturbances during cardiosurgical operations under hypothermia, by intravenous administration of a solution of K + chloride at a dose of 0.5 mmol / kg of patient body weight during the cooling period (RU 2144362, А61К 33/14. Publication date 01/20/2000).

However, this method of prevention does not prevent the occurrence of hypomagnesemia and, consequently, the development of possible heart rhythm disturbances. In 55 examined patients, the plasma concentration of Mg ^{2+ ions} before connecting the heart- ^lung machine was 0.91 mmol / L, significantly decreased after it was turned off, and reached 0.66 mmol / L (p <0.01), which was clinically manifested by a high frequency development of atrial fibrillation, namely in 15.0% of cases.

The closest set of essential features to the claimed invention is a method for the treatment of atrial fibrillation in myocardial infarction, taken as a prototype (RU 2268713, A61K 31/166, A61K 33/06, A61P 9/10. Publication date 01/27/2006), in which the complex of drug therapy includes nibentan, which is administered at a dose of 0.125 mg / kg intravenously. In this case, a solution of magnesium sulfate in a dose of 2.5 g is pre-administered 10-15 minutes before the administration of nibentan. The method provides a quick restoration of sinus rhythm in the absence of complications of therapy.

The disadvantage of the prototype is the restriction of the use as prevention of cardiac arrhythmias, which is important when conducting cardiac surgery.

The technical result of the invention is the prevention of cardiac arrhythmias during cardiac surgery using a cardiopulmonary bypass.

This method is as follows.

The invention is aimed at solving the problem of prevention of hypomagnesemia, and therefore heart rhythm disturbances during cardiac surgery using a cardiopulmonary bypass.

The solution to this problem allows to prevent secondary overload of cells with calcium, to mitigate the effect of hyperkalemia on cardiomycetes, to regulate the loss of potassium by cardiomycetes, reperfusion overload with sodium and the process of depolarization of cardiomycetes.

Magnesium is a critical cofactor for a large number of enzymatic reactions. Magnesium deficiency is accompanied by ventricular arrhythmias, intensification of atherosclerotic vascular damage and increased mortality from cardiovascular disease. Myocardial magnesium deficiency is accompanied by a high probability of arrhythmias after cardiac surgery. The total concentration of magnesium in serum decreases significantly during cardiopulmonary bypass and continues after the device is turned off. In patients who are to undergo cardiac surgery, hypomagnesemia is noted in the preoperative period as a reaction of the body to stress, an additional decrease in the concentration of magnesium in the blood serum during induction before cardiopulmonary bypass is possible due to hemodilution with magnesium-free solutions, even greater hemodilution occurs during cardiopulmonary bypass , magnesium binds to colloidal solutions with which the heart-lung machine is filled. Intraoperative use of magnesium sulfate prevents hypomagnesemia. In addition, a decrease in serum magnesium is due to latent loss of blood from the oxygenator.

During cardiosurgical operations using AIK, the administration of all drugs is carried out in a special drug port (drud-port), since during cardiopulmonary bypass, the cardiotome reservoir with pumps and oxygenator takes over the function of the heart and lungs, and then rinses with blood circulating through the shunts, which prevents the drug from stopping in the non-washable zone of the cardiotome reservoir without effective action. In this case, the plasma concentration of magnesium, which before connecting the cardiopulmonary bypass was 0.7-1.1 mmol / L, remained unchanged (p> 0.05). That is, in comparison with the previously used technique, the concentration of magnesium ions in plasma after turning off the heart-lung machine did not significantly decrease (p <0.01).

The dose of magnesium sulfate administered is 0.05-0.07 mmol / kg of the patient’s body weight before connecting the heart-lung machine and 0.05-0.07 mmol / kg before reperfusion due to the different plasma concentrations of magnesium ions in patients before surgery.

As an illustration of the proposed method for the prevention of cardiac arrhythmias, we provide brief extracts from medical histories.

Example 1

Patient Ka-va ZK, 68 years old, was admitted to the hospital with a diagnosis of coronary heart disease. Angina pectoris FC II. Postinfarction cardiosclerosis. Chronic heart failure II. Hypertension II-III stage, risk IV. Type II diabetes mellitus. The diagnosis is confirmed by the data of a full clinical examination, coronary angiography ECHO ECG. A patient underwent a coronary artery bypass grafting using the technique adopted in the clinic using a heart-lung machine. The plasma concentration of magnesium ions before connecting the heart-lung machine was 0.86 mmol / L. Aortic occlusion time - 38 minutes, cardiac activity recovery time - 2.0 minutes. After turning off the heart-lung machine, the concentration of magnesium ions in the blood plasma was 0.3-0.4 mmol / L. During the entire operational period, cardiac arrhythmias in the form of atrial fibrillation were noted.

Example 2

Patient Sa-va K.P., 73 years old, was admitted to the hospital with a diagnosis of coronary heart disease. Angina pectoris FC III. Postinfarction cardiosclerosis. Chronic heart failure II. Hypertension stage III, risk IV. The diagnosis is confirmed by the data of a full clinical examination, coronary angiography ECHO ECG. The patient underwent surgery of coronary artery bypass grafting III (three-shunt). The dose of magnesium sulfate introduced into a special medicinal port was 0.05 mmol / kg of the patient’s body weight before the cardiopulmonary bypass and 0.05 mmol / kg before reperfusion until the intracardiac stage of the operation was performed. The concentration of magnesium ions in the plasma amounted to 0.90 mmol / L before connecting the heart-lung machine. Aortic occlusion time - 32 minutes, cardiac activity recovery time - 1.5 minutes. After turning off the heart-lung machine, the concentration of magnesium ions in the blood plasma was 1.1 mmol / L.

The technical solution consists in the fact that, in contrast to the prototype, 25% magnesium sulfate is administered through a special drug port at a dose of 0.05-0.07 mmol / kg of the patient’s body weight before connecting the heart-lung machine and 0.05-0.07 mmol / kg before reperfusion before performing the intracardiac phase of the operation.

The proposed method can find application in cardiosurgical clinics for the prevention of cardiac arrhythmias during cardiosurgical operations using a cardiopulmonary bypass.

Claims (1)

A method for the prevention of cardiac arrhythmias during cardiac surgery, including infusion, drug treatment, characterized in that the infusion is carried out using a cardiopulmonary bypass through a special drug port and a 25% solution of magnesium sulfate in a dose of 0.05-0.07 mmol / kg of patient’s body weight before connecting the heart-lung machine and 0.05-0.07 mmol / kg before reperfusion.