冠脉搭桥术后炎症反应与心肌标志物的关系

目的：探讨非体外循环与并行循环方法对心肌损伤和全身炎症反应的差异。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T1（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）不同时间点白细胞数量（WBC）、中性粒细胞（PMN）百分比、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（cTn I）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WBC总数、PMN%、TNF-α、IL-6、IL-8、cTn I含量T1时无统计学意义（P〉0.05）,T2、T3、T4、T5时均呈升高趋势。A组较B组T2、T3、T4、T5各时间点WBC总数、PMN%、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,心肌组织损伤略重;体外循环可加重机体全身炎性反应程度,增加神经系统并发症机率。

Inflammation and Myocardial Markers Relationship After Coronary Artery Bypass Grafting

Objective：To investigate the difference about myocardial injury and SIRS in patient between on-pump beating heart CABG and off-pump CABG.Methods：30 patients from June 2009 to Jan 2010 who underwent the CABG in our hospital with on-pump beating heart CABG and off-pump CABG were selected and which were divided into Group A and group B（each group contained 15 patients）.Serial blood samples were collected at the following intervals：before the operation and 0h,6h,12h,24h after the operation.And the WBC,PMN%,TNF-α,IL-6,IL-8 and cTn I were evaluated.The grafts、mental status、bleeding and the time of intensive care unit were recorded and compared.Results：There was no significant difference between two groups in plasma WBC,PMN%,TNF-α,IL-6,IL-8 and cTn I at T1.The WBC,PMN%,TNF-α,IL-6 and IL-8 increased significantly at T2-T5 compared with that before operation（T1） in both groups.However,the plasma concentrations of WBC,PMN%,TNF-α,IL-6,IL-8 were significantly lower in group B than that in group A.The level of cTnI increased significantly at T2-T3 compared with that at T1,while there was no significantly difference at T4,T5.The general condition of the patients in group B was better than that of the group A.The bleeding was significantly fewer in group B.Conclusions：Myocardial injury was more serious in patients with on pump beating heart CABG than that with off pump CABG.Cardiopulmonary bypass can aggravate inflammatory response and increase the incidence rate of neurological complications.