冠状动脉搭桥术后心脏炎症因子变化

Cardiac Inflammatory Response after Coronary Artery bypass Grafting

目的:探讨冠状动脉搭桥术后心脏炎症对心功能的影响。方法:42例稳定型心绞痛患者行体外循环下冠脉搭桥术。体外循环运行前,心脏复跳后5、20min分别取动脉及冠状静脉窦血标本;检测白细胞介素(IL)-6、IL-8、IL-10,细胞间黏附分子-1(ICAM-1)和P-选择素(P-selectin)等炎症因子及乳酸水平。记录术后患者肌酸激酶同工酶(CK-MB)、肌钙蛋白-I变化及血流动力学资料。结果:体外循环前IL-6动脉血水平低于冠状静脉窦血水平(P<0.05)。ICAM-1及P-selectin水平高于冠状静脉窦水平(P<0.05)。主动脉开放心脏复跳后动脉血IL-6、IL-8、IL-10、ICAM-1及P-selectin水平与冠状静脉窦水平差别无统计学意义。主动脉开放后20minIL-6、ICAM-1桡动脉和冠状静脉窦血水平差值(CS-A)与术后12h心排指数呈弱负相关。体外循环前动脉血乳酸水平高于冠状静脉窦水平(差值,-0.14±0.25),再灌注阶段心脏乳酸高于体外循环前水平(差值,5min时,0.36±0.22;20min时,0.14±0.20,与术前比较,P<0.01)。主动脉开放后20min后经心乳酸(CS-A)与术后24、48h心肌酶呈正相关。结论:体外循环冠脉搭桥术后心脏炎症反应与术后心功能损害有关,抑制心肌炎症反应有可能改善术后心功能。

Objective： To investigate the effect of myocardial inflammatory response after coronary artery bypass grafting on heart function. Methods： Forty-two patients with stable angina undergoing coronary artery bypass grafting （CABG） with cardiopulmonary bypass （CPB） were invited to participate the study. Samples from radial artery and coronary, sinus were taken before CPB, and five and twenty minutes after aortic declamping. Plasma interleukin （IL）-6, 8,10, ICAM-1, P-selectin and lactate were measured. Post-operative CK-MB, tropnin-I and hemodynamics were recorded. Results： Lower IL-6 and higher ICAM-1, P-seleetin levels of radial artery were found before CPB as compared to those of coronary sinus（P 〈 0.05）. IL-6,8,10, ICAM-1 and P-seleetin levels in artery after aortic declamping no difference compared with those of coronary, sinus. Transeardiae gradient of IL-6 and ICAM-1 levels （CS-A） in radial artery and coronary sinus twenty minutes after declamping were weakly correlated to cardiac index twelve hours after CPB.Laetate levels in artery before CPB were higher than that of coronary sinus （gradient,-0.14±0.25）. Transcardiae gradient of lactate after aortic declamping （CS-A）was higher than that before CPB （gradient,0.36±0.22 in five minutes;0.14±0.20 in twenty minutes compared with preoperation （P 〈 0.01）. Lactate gradient twenty minutes after aortic declamping （CS-A） was posivively correlated to myocardial enzyme levels after 24 and 48 h operation Conclusion： The present study confirm that myoeardium injury after CABG is correlated to cardiac inflammatory response; suppression of the cardiac inflammatory response may improve myocardial protection.