冠状动脉旁路移植术患者围术期内皮素和降钙素基因相关肽的动态变化

Dynamic Changes of Endothelin and Calcitonin Gene-related Peptide in Perioperative Period of Coronary Artery Bypass Grafting

目的观察在体外循环下行冠状动脉旁路移植术(CABG)患者围手术期血液中内皮素(ET-1)和降钙素基因相关肽(CGRP)的动态变化及与并发症关系。方法对36例行冠状动脉旁路移植术的病人,用放射免疫法测定围手术期即术前、麻醉诱导期、阻断升主动脉、开放升主动脉、术后2、6、12、24、72h不同时相血浆中ET-1和CGRP的含量变化。结果冠心病病人术前血浆ET-1浓度为(97±14)ng/L,阻断升主动脉后、术后2、6、12h时血浆ET-1水平均较术前明显升高,差异有统计学意义(P<0.05或P<0.01);术前CGRP血浆浓度为(50.6±24.5)pg/mL,在开放升主动脉、术后2、6、12、24、72h时,CGRP水平随开放时间的延长逐步升高,差异与术前比较有统计学意义(P<0.01或P<0.05)。术后出现不同并发症,ET-1均有明显变化。结论ET-1升高程度与心肌损伤程度相一致,与术后并发症有关;内源性CGRP对体外循环缺血—再灌注心肌具有代偿性的保护作用。

Objective To observe the changes of endothelin and calcitonin gene- relate peptide in the perioperative period of coronary artery bypass grafting（CABG）, and to discuss the pathophysiological implication of these alterations. Methods The blood plasma concentrations of ET- 1 and CGRP were measured in 36 CABG patients at different phases of periopemfive periods with radioimmunoassay and compared with that of control group. Results Preoperative plasma ET- 1 concertmtions were（97 ± 14）ng/L in patients with coronary artery diseases and increased significantly after aortic cross - clamping, post operation 2h, 6h, 12h. Preoperative plasma CGRP concentrations were（50.6 ± 24.5）pg/mL and elevated gradually with the time extension of cross- clamping removed, post operation 2h, 6h, 12h, 24h, 72h. Significant differences were presented pre and post operation. Postoperative complication occurred while ET- 1 enhanced markedly. Conclusion ET- 1 concentrations increase with the severity of myocardial injury and are correlated with postoperative complications. Endogenous CGRP has compensative protective action on ischemia- reperfusion myocardium during CPB.