Study of the effectiveness of fructose-1,6-diphosphate in the complex treatment of cardiac surgery patients who underwent coronary artery bypass grafting with cardiopulmonary bypass
Background. Coronary heart disease is the accumulation of atherosclerotic plaques in the blood vessels that supply the heart with oxygen and nutrients. Coronary artery bypass grafting is a strategy for myocardial revascularization that is indicated for patients with three or more coronary artery dam...
| Main Authors: | , |
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| Format: | Article |
| Language: | English |
| Published: |
Zaslavsky O.Yu.
2022-04-01
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| Series: | Медицина неотложных состояний |
| Online Access: | https://emergency.zaslavsky.com.ua/index.php/journal/article/view/1472 |
| Summary: | Background. Coronary heart disease is the accumulation of atherosclerotic plaques in the blood vessels that supply the heart with oxygen and nutrients. Coronary artery bypass grafting is a strategy for myocardial revascularization that is indicated for patients with three or more coronary artery damage, high SYNTAX, diabetes, and left ventricular systolic dysfunction. In the vast majority of cases, CABG is currently performed with cardiopulmonary bypass. During the cardiopulmonary bypass, under the influence of a number of factors, there is a decrease in the level of some electrolytes. One of them is phosphorus — an important element for all living cells, which performs various functions. The purpose of the study was to study the effectiveness of fructose-1,6-diphosphate in order to prevent and reduce the severity of acute left ventricular failure in patients who underwent surgery — coronary artery bypass grafting with cardiopulmonary bypass, in which hypophosphatemia was detected before surgery. Materials and methods. 500 patients were operated on at the State Scientific Institution “Scientific and Practical Center of Preventive and Clinical Medicine” of the Agency of State Affairs. All underwent coronary artery bypass graft surgery with cardiopulmonary bypass. 60 patients were selected who were diagnosed with hypophosphatemia at the preoperative stage. Hypophosphatemia refers to a decrease in phosphate levels below normal, or levels approaching the lower limit of normal. The main group included 30 patients, for the correction of phosphate levels used fructose-1,6-diphosphate (drug Esafosfina). The control group also included 30 patients, no correction of phosphate levels was performed. No statistically significant differences in groups (by sex, age, number of bypasses imposed) were found, p > 0.05. The study of phosphate levels was performed before surgery, immediately after the end of cardiopulmonary bypass and in the early postoperative period in the dynamics. Results. The introduction of fructose-1,6-diphosphate was carried out (according to the manufacturer’s instructions) in an amount of 10 g as an intravenous infusion during cardiopulmonary bypass. An increase in the level of phosphates with fructose-1,6-diphosphate after administration of the drug in the main group, p < 0.05. Hemodynamic disorders after surgery, in the case of fructose-1,6-diphosphate, occurred 1.76 times less often (p < 0.05) than in the group where the correction of hypophosphatemia was not performed. In the case of acute left ventricular failure after CABG with artificial circulation, the recovery time of hemodynamics from surgery to stabilization was twice (p < 0.05) shorter in the main group compared with the control. And the amount of inotropic drug (dobutamine) consumed in the main group was 2.6 times (p < 0.05) less than in the control group. Conclusions. The use of the fructose-1,6-diphosphate in the complex treatment of cardiac surgery patients who underwent coronary artery bypass grafting with cardiopulmonary bypass, significantly corrects hypophosphatemia (increases phosphate levels). Administration of fructose-1,6-diphosphate reduces the incidence of acute left ventricular failure after CABG with cardiopulmonary bypass, in a group of patients who were diagnosed with hypophosphatemia before surgery. In case of its development, the appointment of fructose-1,6-diphosphate leads to a reduction in the recovery time of hemodynamics and a reduction in the total dose of inotropic drug (dobutamine), necessary to achieve stabilization. |
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| ISSN: | 2224-0586 2307-1230 |