体外循环与非体外循环下冠状动脉旁路移植术对血脂和高敏C反应蛋白的影响

Comparative studies of blood lipids and serum high sensitive Creactive protein in patients undergoing coronary artery bypass grafting under on-pump and off-pump bypass

目的对比研究41例常规体外循环冠状动脉旁路移植术(CCABG)和38例非体外循环冠状动脉旁路移植术(OPCAB)对血脂和高敏C反应蛋白(HsCRP)水平影响及其意义。方法分析79例冠状动脉旁路移植术术(CABG)前、术后24小时、72小时、7天、10天、14天、28天血浆总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)和HsCRP水平,测试期间未服用调脂药物。结果①CCABG组和OPCAB组两组之间差别无统计学意义(P>0.05),术后两组均可见24小时、72小时、7天、10天、14天TC、LDL-C明显下降(P<0.001),其中术后24小时达最低值,以后各时段逐渐升高但仍低于术前(P<0.001),28天超过术前基线水平(P<0.05);②TG、HDL-C术后24小时达最低值(P<0.001),72小时、7天、10天、14天与术前比较差别无统计学意义(P<0.05),TG 28天超过术前基线水平(P<0.05);③HsCRP术后24小时升高,72小时达峰值,以后各时段逐渐降低但仍高于术前(P<0.001),28天恢复至基线水平(P>0.05)。结论两种术式对血脂代谢均有影响,HsCRP的变化提示术后存在炎症反应过程。

Objective To compare the influences of coronary artery bypass grafting under on-pump（CCABG） and off-pump bypass（OPCAB） on blood lipids and serum high sensitive C-reactive protein（HsCRP）. Methods Fortyone patients underwent CCABG and 38 patients underwent OPCAB. The serum levels of total cholesterol （TC）, triglycerides（TG）, HDL-C cholesterol（HDL-C）, LDL-C cholesterol（LDL-C） and HsCRP were monitored before and 24 h, 72 h, 7 day, 10 day, 14 day, 28day after operation in all the patients. None of them received lipid-lowering drug during the test. Results ①There were no significant difference between two groups（ P 〉0.05）. The serum levels of TC,LDL-C decreased significantly in 24 h, 72 h, 7 day, 10 day, 14 day after operation（ P 〈0. 001）. The level in 24 h was the lowest, then began increasing; until 28 days after operation the serum levels of TC, LDL-C exceeded preoperative baseline level（ P 〈0.05）. ② The level of TG and HDL-C in 24 h was the lowest（ P 〈0. 001）, then began increasing（ P 〉0.05）. Until 28 days after operation the serum levels of TG exceeded preoperative baseline level （ P 〈0.05）. ③ HsCRP showed a significant rise 24 h after operation（ P 〈0.05）, and peaking at 72 h（ P 〈0.05） postoperatively, and droped markedly on the 14th day after operation（ P〈0.05）, and reached baseline values until 28 day postoperatively（ P 〉0.05）. Conclusion Both ways of the operation present significant influence on blood lipids. The change of HsCRP shows that there exists inflammatory reaction in CABG.