非体外循环与并行循环不停跳冠脉搭桥术炎性因子的比较

目的:通过对比非体外循环与并行循环下不停跳冠脉搭桥术炎性因子的变化,研究不同方法对机体全身炎性反应程度的影响.方法:选择2009年6月～2010年1月在我院行冠脉搭桥术患者30例,其中选取采用并行循环下不停跳冠脉搭桥术(OnP-BH CABG)和非体外循环冠脉搭桥术(OPCABG)患者各15例,即A组和B组.检测TI(术前)、T2(手术结束时)、T3(术后6小时)、T4(术后12小时)、T5(术后24小时)不同时间点血浆肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)、白介素-8(IL-8)、肌钙蛋白I(cTnI)含量,并记录桥血管数量、精神状况、引流量及ICU入住时间.结果:两组血浆TNF-α、IL-6、IL-8、cTnI含量T1时无统计学意义(P＞0.05),T2、T3、T4、T5均呈升高趋势.A组较B组T2、T3、T4、T5各时间点TNF-α、IL-6、IL-8指标升高差异显著(P＜0.01);cTn I升高幅度略缓,T4、T5差异无统计学意义.比较患者术后精神状况及ICU入住时间,B组均优于A组(P＞0.05).术中搭桥血管支数无统计学差异、A组引流量较B组多,有统计学意义(p=0.02).结论:并行循环下不停跳冠脉搭桥术与非体外循环冠脉搭桥术相比,心肌损伤略重;体外循环可加重机体全身炎性反应程度.

The Comparison of Inflammatory Factor Between On-Pump and Off-Pump Coronary Artery Grafting Surgery Beating Heart

Objeaive:To investigate the differences of inflammatory cytokines level and inflammatory reaction in patients between on-pump beating heart CABG and off-pump CABG.Methods:30 patients,who underwent the CABG from June 2009 to Jan 2010 in our hospital were chosen.There were on-pump beating heart CABG group(Group A)and off-pump CABG group(group B).Serial blood samples were collected at the following intervals respectively:before operation and Oh,6h,12h,24h after the operation.The concentration of TNF-α,IL-6,IL-8 and cTn 1 were detected.The grafts,mental status,bleeding and the time ofintensive care unit was recorded and compared.Results:There was no significant difference between two groups for plasma TNF-α,IL-6,IL-8 and cTn I level at T1.The TNF-α,IL-6 and IL-8 increased significantly at T2-T5 compared with that before operation(TI)in both groups.However,the plasma concentrations of TNF-α,IL-6,IL-8 were significantly lower in group B than that in group A.The level of cTnI B Was better than that in group A.The bleeding was significantly fewer in groups B.Conclusions:Myocardial injury was slightly heavier in patients with on pump beating heart CABG than off pump CABG.Cardiopulmonary bypass can aggravate inflammatory reac-tion.