体外循环及非体外循环下冠状动脉搭桥术对患者免疫功能的影响

A comparision of immune function in patients undergoing CABG with off-pump technique or extracorporeal circulation

目的 探讨体外循环心脏停跳下冠状动脉搭桥术 (ECCAB)与非体外循环心脏不停跳冠状动脉搭桥术 (OPCAB)对患者术后免疫功能的影响。方法 1 6例首次择期行冠状动脉搭桥术的患者 ,按是否应用心肺转流 (CPB)随机分为ECCAB组 (A组 )及OPCAB组 (B组 ) ,每组 8例 ,分别于麻醉诱导后、术毕、术后第 1、2天抽取外周静脉血 ,ELISA法测定白细胞介素 6 (IL 6 ) ;流式细胞术直接免疫标记技术测定T细胞亚群CD4 + 、CD8+ ,并计算CD4 + /CD8+ 。结果 与麻醉诱导后相比 ,两组患者于术毕、术后第 1天IL 6上升 ,CD4 + 下降 (P <0 0 5 ) ,且A组较B组更为明显 (P <0 0 5 )。B组IL 6、CD4 + 于术后第 2天与麻醉后比较已无差异 ,而A组仍高于麻醉诱导后。CD8+ 两组变化趋势相同 ,于术毕下降最低 ,逐渐恢复 ,但至术后第 2天仍显著低于麻醉诱导后。结论 与ECCAB术相比 。

Objective To evaluate the effects of coronary artery bypass grafting (OPCAB) or CAB under extracorporeal circulation (ECCAB) on the immune function.Methods Sixteen patients undergoing elective coronary artery bypass grafting (CABG) were divided into two groups of ECCAB(group A)and OPCAB(group B),with 8 cases each.Interleukin 6(IL 6),T lymphocyte subsets (CD4 +,CD8 +)as the parameters of acute phase responses were measured after induction of anesthesia,at the end of operation,and on the 1 st ,2 nd postoperative day.Results In two groups,CD4 +,CD8 +,CD4 +/CD8 + were all decreased and IL 6 increased significantly at the end of operation and on the 1 st and 2 nd postoperative day compared with those after induction,which was more in group A than that in group B.IL 6 and CD4 + were still significantly higher than those after induction,but not changed markedly in group B.Conclusions OPCAB has less effect on the imflamatory response and immune function than ECCAB. [