常规体外循环和非体外循环冠状动脉旁路移植术的对比研究

Comparative study on systemic inflammatory response syndrome and myocardial injury after on-pump and off-pump coronary artery bypass grafting

目的通过比较常规体外循环冠状动脉旁路移植术(CPBCABG)和非体外循环冠状动脉旁路移植术(OPCABG)患者炎性因子和心肌损伤的差异及远期结果,评价两种术式的优缺点。方法48例行择期行冠状动脉旁路移植术患者,随机分成CPBCABG组(n=22)和OPCABG组(n=26)。分别麻醉诱导后及术后2h,8h,24h和48h5个时间点留取静脉血6ml。测定白细胞介素6(IL-6)、白细胞介素8(IL-8)、肿瘤坏死因子α(TNF-α)和肌钙蛋白I(cTnI)。随访患者心绞痛改善情况及心功能情况,随访时间1.5年。结果CPBCABG组术后各项指标均较术前显著升高(P<0.05)。OPCABG组除IL-6,TNF-α外其余指标较术前无明显升高,差异无统计学意义(P>0.05),两组术前各项参数间均无统计学差异,术后CPBCABG组各项参数均明显高于OPCABG组(P<0.05),尤以术后2h和8h差异最为明显(P<0.05或P<0.01)。随访两组患者均无残留心绞痛,恢复正常生活或工作。结论与CPBCABG相比较,OPCABG可以明显降低围术期炎性反应,减轻心肌损伤,而远期效果同样满意。

Objective To investigate the effect of multiple coronary artery bypass grafting（CABG）with or without eardiopulmonary bypass（CPB）on perioperative systemic inflammatory response and myocardial injury of the patients. Methods Forty eight patients with multivessel disease were randomly assigned into conventional on-pump coronary artery bypass grafting group（CPBCABG group, n =22）and off-pump coronary artery bypass grafting group（OPCABG group, n = 26）. Venous blood samples of 48 patients were colleered after the induction of anesthesia and after surgery for 2,8,24 and 48 h. The levels of interleukin 6 （IL-6）, IL-8, TNF-α and cTnⅠ in plasma were measured. The patients were followed up for 1.5 years. Results There was no significant difference in age,sex, weight, extent of coronary disease, left ventricular function, number of grafts per patient, methods and drugs during anesthesia between two groups. Compared with that before surgery, the levels of IL-6, IL-8, TNF-α and cTnⅠ in CPBCABG group significantly increased at all the time points after surgery（P〈0.05）. The levels of IL-8 and cTnI increased in OPCABG group,but there was no significant difference at all the time points（P〉0.05）. The level of IL-6 in OPCABG group significantly increased at 2 h and 8 h after surgery （P〈0.05）. The level of TNF-α in OPCABG group was significantly elevated at 2 h after surgery（P〈 0.05）. The levels of IL-6, IL- 8,TNF-α and cTnⅠ in CPBCABG group were significantly higher than in OPCABG group at all the postoperative time points（P〈 0.05 or P〈 0.01 ）. The patients recovered with normal cardiac function during fouow-up. Conclusion Off-pump coronary bypass grafting could significantly reduce the inflammatory reaction and myocardial injury associated with the use of CPB.