低心排血量综合征中总抗氧化能力的变化及其临床意义

The changes and significance of total antioxidative capacity in low cardiac output syndrome

目的：探讨冠心病患者实施冠状动脉旁路移植术（CABG）后,发生低心排血量综合征（LCOS）的患者与未发生 LCOS 的患者间血浆总抗氧化能力（T-AOC）的变化情况及其临床意义。方法选取2013年5月—2014年7月蚌埠医学院第一附属医院胸心外科81例冠心病患者进行前瞻性研究。81例患者均采用 CABG 治疗,采集所有患者术前、术中及术后中心静脉血液标本,采用2,2-联氮双（3-乙基苯并噻唑啉-6-磺酸）二铵盐（ABTS）快速法检测血浆 T-AOC 水平。根据术后是否发生LCOS 将患者分为 LCOS 组与非 LCOS 组,观察2组患者年龄、桥血管数、体外循环时间、主动脉阻断时间、术后重症监护治疗病房（ICU）留观时间、呼吸机支持时间、住院时间以及术前、术中及术后的血浆T-AOC 变化情况。结果81例患者中,9例（11.11%）患者发生 LCOS,72例（88.89%）患者未发生LCOS,LCOS 组与非 LCOS 组各有1例患者死亡。 LCOS 组患者与非 LCOS 组患者年龄和桥血管数的差异均无统计学意义（t 值分别为-0.444、-0.164,P 值均〉0.05）。而 LCOS 组患者体外循环时间、主动脉阻断时间、术后 ICU 留观时间、呼吸机支持时间和住院时间均明显多于非 LCOS 组,差异均有统计学意义（t 值分别为-5.524、-8.120、-9.526、-4.589、-5.787,P 值均〈0.01）。术前2组患者血浆 T-AOC 水平的差异无统计学意义（t =0.746,P 〉0.05）；与术前比较,2组患者术中、术后 T-AOC 均呈下降趋势,差异均有统计学意义（F 值分别为431.679、126.474,P 值均〈0.01）；LCOS 组患者术中、术后 T-AOC 均低于非 LCOS 组,尤其以术后降低更明显,差异均有统计学意义（t 值分别为5.442、12.942,P 值均〈0.01）。 T-AOC 的 ROC 曲线面积约为0.879,显示利用血浆 T-AOC 含量推测是否发生 LCOS 有较高的准确性,其灵敏度为87.5%,特异度为77.5%。结论冠心病患者在实施CABG 手术过程中发生血浆 T-AOC 的降低,且术后发生 LCOS 的患者 T-AOC 降低的更明显,这可能与术中的缺血再灌注损伤或氧化应激反应有关。在冠心病患者实施 CABG 术中常规检测血浆 T-AOC的变化情况,可能对潜在性的 LCOS 起到早期评估和预警作用。

Objective To investigate the mutative situation and clinical significance of plasma total antioxidant capacity （T-AOC） in patients with low cardiac output syndrome （LCOS） and non-LCOS after coronary artery bypass graft （CABG）. Methods The clinical data of 81 coronary heart disease patients who underwent CABG in Department of Thoracic and Cardiovascular Surgery of the First Affiliated Hospital of Bengbu Medical College from May 2013 to July 2014 were prospectively studied. All 81 patients were treated by CABG, and the central venous blood samples were obtained immediately before surgery, during operation, and at the end of surgery to assess T-AOC by using Diammonium 2, 2′-azino-bis （ 3-ethylbenzothiazoline-6-sulfonate （ ABTS）. Patients were divided into groups LCOS and non-LCOS group, according to postoperative condition. The each patient′s age, grafts, cardiopulmonary bypass time, aortic crossclamp time, postoperative ICU stay time, ventilation support time, hospitalization time and the mutative situation of T-AOC of before, during and after surgery were recorded. Results LCOS developed in 9 patients （11. 11% ）, and the remaining 72 patients （88. 89% ） with non-LCOS in these 81 patients. Both LCOS group and non-LCOS group had 1 patient dead. There were no significant differences between LCOS group and non-LCOS group patients with their age and grafts （ t values were - 0. 444, - 0. 164,＆amp;nbsp;respectively, all P values 〉 0. 05）. Yet cardiopulmonary bypass time, aortic crossclamp time, postoperative ICU stay time, ventilation support time and hospitalization time of the LCOS group were significantly longer than the non-LCOS group, and they were statistically significant （ t values were - 5. 524, - 8. 120,- 9. 526, - 4. 589, - 5. 787, respectively, all P values 〈 0. 01）. There were no significant differences between two groups with the serum T-AOC （t = 0. 746, P 〉 0. 05）. Compared with the preoperative, two groups of patients′ intraoperative and postoperative T-AOC showed a downward trend, the differences were statistically significant （ F values were 431. 679, 126. 474, respectively, all P values 〈 0. 05 ）. The intraoperative and postoperative T-AOC of the LCOS group patients was lower than those of non-LCOS, especially. Postoperative to reduce more obvious, the differences were statistically significant （t values were 5. 442, 12. 942, respectively, all P values 〈 0. 01）. In addition, ROC area was 0. 879. It means that we would have good reliability when we use plasma T-AOC value to surmise whether LCOS would happened, and its sensitivity was 87. 5% , specificity was 77. 5% . Conclusions The plasma T-AOC levels of patients with coronary heart disease in the process of implementation of CABG will decrease, and plasma T-AOC of patients in postoperative LCOS decreased more significantly. Maybe is related to chemical reperfusion injury or oxidative stress. Routine measurement of the T-AOC during operation can provide information for early assessing and warning of the LCOS development.