Effects of Corocalm (Shuguan Capsule, 疏冠胶囊) on acute myocardial ischemia in anesthetized dogs

Objective:To investigate the effects of Corocalm (Shuguan Capsule,疏冠胶囊) on acute myocardial ischemia in anesthetized dogs and its possible therapeutic mechanism.Methods:The acute ischemia model was established by ligating the left anterior descending (LAD) artery.Twenty- five dogs were randomly divided into 5 groups (5 clogs in each group):the control group (treated with normal saline 3 mL/kg),the refined Guanxin Capsule group (精制冠心胶囊,GXC 200 mg/kg),high and low dose Corocalm groups (48.5 mg/kg for low dose group and 194.0 mg/kg for high dose group) and the Diltiazem group (5 mg/kg).The animals were treated via a single duodenal administration after the model was established.The experiments used epicardial electrocardiogram (EECG) to measure the scope and degree of myocardial ischemia.Simultaneously,the coronary blood flow (CBF) and serum activity levels of creatine phosphokinase (CK) and lactate dehydrogenase (LDH) were measured by electromagnetic flow meter and automatic biochemical analyzer respectively.The plasma endothelin (ET) content was quantified by radioimmunoassay.Results:Corocalm (48.5 mg/kg and 194.0 mg/kg) significantly decreased the degree and scope of myocardial ischemia,reduced the infarct area,markedly increased the CBF,and inhibited the increase of CK and LDH activities and ET levels induced by myocardial ischemia/infarction.Conclusion:Corocalm could improve the state of acute myocardial ischemia and infarction in dogs.The mechanism of action might be correlated to increasing CBF, inhibiting CK and LDH activities and preventing ET release.     

Protective effects of the preconditioning with different doses of sodium aescinate on tourniquet-induced ischemic reperfusion

Objective:To evaluate the protective effects of sodium aescinate(SA)preconditioning on the tourniquet-induced ischemia-reperfusion(l/R)injury after limbs operation.Methods:Seventy-five patients with gradeⅠ-Ⅱissued by American Society of Anesthesiology undergoing lower limb operation were randomly assigned to 3 groups:the control group,low-dose SA-treated group and high-dose SA-treated group;each group enrolled 25 patients.The patients were treated with 5 mg and 10 mg SA 30 min before tourniquet inflation in the two treatment groups separately,while the patients in the control group received normal saline.Venous blood samples were obtained before tourniquet was inflated(T0 baseline).And 5(T1),10(T2),20(T3)min after tourniquet was released.The nitric oxide(NO),malondialdehyde(MDA)and superoxide dismutase(SOD)levels were determined by commercial kits.Meanwhile,arterial pressure(MAP)and heart rate(HR)were monitored from an automatic invigilator.Results:In the control group,MDA and NO levels were increased,and SOD and MAP were decreased significantly after tourniquet deflation compared to TO baseline(P<0.05).After tourniquet deflation,MDA and NO levels in the two treated groups were significantly decreased;meanwhile,SOD levels and MAP were increased,and the variations of HR were more stable compared with the control group(all P<0.05).There was no significant difference in all of the above between the two treated groups(P>0.05). Conclusion:The protective effects of SA preconditioning on tourniquet-induced limb l/R injury might possibly contribute to the increasing of SOD levels,and MAP and the decreasing of MDA and NO levels.     

Kyoto Breast Cancer Consensus Conference

Background To date, there have been no reports on altered nitric oxide （NO） content in ischemia/reperfusion with regard to in vivo preconditioning procedures. These studies are important for understanding the mechanisms of NO during early myocardial ischemic preconditioning. The aim of the present study was to investigate the mechanisms of NO during early myocardial ischemic preconditioning by measuring levels of NO and cyclic guanosine monophosphate （cGMP）, as well as activity of nitric oxide synthase （NOS） in ischemia/reperfusion with respect to preconditioning in rats.
Methods Sixty-six female Sprague-Dawley rats were randomly divided into four groups： ischemic preconditioning group （IP）, ischemia/reperfusion group （I/R）, control group （CON）, and preconditioning procedure group （PC）. In the PC group, rats were further divided into PC1-, PC1＋, PC2-, PC2＋, PC3-, and PC3＋ subgroups. Rats underwent left coronary artery occlusion and reperfusion, and subsequently, NOS activity and levels were assessed with spectrophotometric analysis. cGMP contents were measured with radioimmunoassay.
Results The level of NO and cGMP, as well as the activity of NOS, were significantly higher in the IP group compared to the I/R and CON groups （P 〈0.05）. During preconditioning prior to prolonged ischemia, NO and cGMP levels varied markedly with ischemia and reperfusion. The levels of NO repeatedly increased when the heart was exposed to three episodes of 5-minute ischemia, and were almost completely reversed during each reperfusion period. NO and cGMP levels were significantly different between the 5-minute period of ischemia and the same period of reperfusion during preconditioning.
Conclusions NO plays an important role during early phase myocardial ischemic preconditioning in rats. NO and cGMP could be triggers and mediators of early phase myocardial ischemic preconditioning. Altered NOS activity following ischemic stress could be the primary inducer of higher NO levels detected. NO     

Protective Effect of Electroacupuncture and Ischemic Preconditioning on the Circulatory Function in Pigs with Ischemia/Reperfusion Myocardial Injury

Objective: To investigate the effects of electroacupuncture and ischemic preconditioning (IPC) on circulatory function in pigs with myocardial ischemia/reperfusion injury. Method: Eighteen pigs with myocardial ischemia/reperfusion injury were randomly allocated into three groups, 6 in each. Group I was the control group, group II was the group that received IPC, and group III was that received both electroacupuncture and IPC. Blood malondialdehyde (MDA), superoxide dismutase (SOD), creatine phos-phokinase (CPK) and its isoenzyme (CK-MB), coronary artery flow and myocardial heat-shock protein (HSP) mRNA expression were detected for evaluation. Results: After treatment, the MDA content was decreased and SOD activities increased significantly in the acupuncture and IPC group compared with the control group (P<0. 05 respectively). The levels of CPK, CK-MB at 20, 60 min after reperfusion were significantly higher than those before treatment, but the levels in group III and group n were remarkably lower than     

Matrix metalloproteinase-8 inhibitors mitigate sepsis-induced myocardial injury in rats

Background Sepsis-induced myocardial injury （SIMI） is caused by a variety of mechanisms. The aim of the study is to investigate the effects of metalloproteinase-8 （MMP-8） on SIMI and its mechanisms in rats. Methods Forty male Sprague Dawley rats were randomly divided into four groups： MMP-8 inhibitor （M81）, dexamethasone （DEX）, sepsis, and sham groups. The sepsis model was established by cecal ligation and puncture （CLP）. Rats in the M81 group immediately received an intraperitoneal injection of M81 （0.1 mg/kg） after CLP. Rats in the DEX group immediately received an intraperitoneal （IP） injection of DEX （2 mg/kg）. Rats in the sepsis and sham groups received intraperitoneal injections of normal saline. Rats were sacrificed 12 hours after CLP. Paraffin sections were stained with hematoxylin and eosin to observe the myocardium. The myocardial ultrastructure was observed with transmission electron microscopy. MMP-8, tumor necrosis factor-Q （TNF-a）, and interleukin-113 （IL-113） were detected by immunohistochemistry. The expression of MMP-8 was measured by Western blotting. TNF-a and IL-113 levels in serum and myocardial tissue were determined by enzyme-linked immunosorbent assay. Results Compared with the sham group, the myocardium in the sepsis group was seriously injured. MMP-8, TNF-α and IL-1β expression was higher in the sepsis group than in the sham group, Treatment with M81 or DEX, however, attenuated sepsis induced histopathological changes in the heart, and was associated with significant reductions in serum and myocardial levels of TNF-a and IL-113 （P 〈0.05）. M81 significantly inhibited MMP-8 expression in myocardial tissue （P 〈0.05）. In addition, treatment with DEX was not associated with a change in myocardial levels of MMP-8 （P 〉0.05）. Conclusion MMP-8 inhibitor attenuated myocardial injury in septic rats, which might be related to reduced expression of TNF-α and IL-1β.     

Study on the Protective Effect of Shengmai San(生脉散) on the Myocardium in the Type 2 Diabetic Cardiomyopathy Model Rat

Objective:To study the effect of Shengmai San(生脉散Pulse-activating Powder) in protecting myocardium in the rat of the type 2 diabetic cardiomyopathy(DCM) model.Methods:The DCM rat model was established by combination of insulin resistance induced by a high-fat diet with intraperitoneal injection of high dose streptozotocin(50 mg/kg).And these rat models were randomly divided into three groups:a normal group(n=12,one of them died),a model group(n=15) and a Shengmai San group(treatment group,n=15).The damage of the myocardium was assessed by electrocardiogram at the twelfth week after modeling,and the blood glucose,cholesterol and triglyceride levels were determined;the content of the left cardiac ventricle myocardial collagen was quantified by Masson staining test;the level of myocardial cell apoptosis was detected with TUNEL apoptosis detection kit;the damage extent of the myocardial sub-cellular structures was observed by electron microscopy;the expression levels of cardiac TSP-1(Thrombospondin-1),TGF-β1(Transforming Growth Ffactor-β) and TRB-3(Tribbles homolog 3) proteins were detected by immunohistochemical method;the expression levels of cardiac TSP-1,A-TGF-β1 and L-TGF-β1 proteins were detected by Western blotting;and the expression levels of TSP-1 and TRB-3 mRNAs were detected by real-time quantitative PCR.Results:Compared with the control group,the blood glucose,cholesterol,triglycerides levels in both the model groups and the Shengmai San group were significantly decreased;the myocardial tissue was less damaged and the collagen content was reduced in the Shengmai San group;the myocardial sub-cellular structure was injured to a lesser extent;the expression levels of myocardial TSP-1,TGF-β1,TRB-3,and TSP-1,A-TGF-β1,L-TGF-β1 and chymase were decreased,and the expression levels of TSP-1 mRNA and TRB-3 mRNA were decreased in both the model groups and the Shengmai San group(the latter was better),.Conclusion:Shengmai San can inhibit myocardial fibrosis in the rat of diabetic cardiomyopathy,and significantly delay the formation of diabetic cardiomyopathy in hyperglycemia rats through multiple pathways.     

Effect of ecdysterone on heteroptopic heart transplantation in rats

Objective:To investigate the protective effects of ecdysterone(EDS)on the allograft heart transplant model of rats.Methods:Fifty healthy Sprayue-Dawley(SD)rats were divided into donors and recipients randomly.Hearts were harvested and placed heterotopically into allogenic recipients.All animals were divided into three groups:sham-operation group(only opening and closing the abdomen, n=10),EDS group(injected intraperitoneally with 20 mg/(kg·day)of EDS,n=10),and control group(injected intraperitoneally with normal saline,n=10).The pathological changes of myocardial tissue were analyzed by light microscopy and transmission electron microscopy and the levels of myocardial enzymes(GOT,LDH,CPK),SOD,ET-1,NO,MDA in serum were measured.Tissue samples underwent the detection of apoptotic cell death by in situ terminal deoxyribonucleotide transferase-mediated dUTP nick end labeling for apoptotic index(AI)and also by immunohistochemistry method to study the expressions of Bcl-2 and Bax.Results:Pathological examination and transmission electron microscope observation showed greater myocardium damage in the control group.EDS group showed a decrease in the amount of myocardial enzymes,MDA,ET-1 and an increase in the levels of SOD,NO,compared to the control group.The AI of EDS group became lower than that of control group,meanwhile the EDS group increased the expression of Bcl-2 and decreased the expression of Bax.Conclusion:EDS has protective effects on heteroptopic heart transplantation,which provides a new idea for myocardial protection in heart transplantation.However,the mechanism of its protective effect needs further research.     

Comparison of remifentanil and fentanyl in patients undergoing modified radical mastectomy or total hysterectomy

Objective To compare the efficacy and safety of remifentanil and fentanyl in patients undergoing a modified radical mastectomy or total hysterectomy.Methods Fifty-four patients were evenly randomised into remifentanil group and fentanyl group. Anesthesia was induced by propofol (1-2 mg/kg) and either remifentanil (2 μg/kg) or fentanyl (2.5 μg/kg), and was maintained with inhalation of nitrous oxide in oxygen (2∶1) and continuous infusion of either remifentanil (0.2 μg·kg-1·min-1) or fentanyl (0.03 μg·kg-1·min-1). Results The number of patients exhibiting light anesthesia responses in the remifentanil group during intubation and the maintenance of anesthesia was significantly less than that in the fentanyl group. Both systolic and diastolic blood pressures in the fentanyl group were significantly higher than those in the remifentanil group during intubation, skin incision, maintenance of anesthesia and extubation. The time to opening eyes on command and the time for extubation after surgery was comparable between the two groups. More patients in the remifentanil group (25 patients) required bolus injection of morphine for postoperative pain relief than those in the fentanyl group (5 patients, P&lt;0.05). There was no significant difference between the two groups in terms of side effects.Conclusions Under the condition of this study protocol, the anesthetic and analgesic effects of remifentanil are more potent than those of fentanyl. Remifentanil can offer superior intraoperative hemodynamic stability in comparison with fentanyl, and has no compromising recovery from anesthesia.     

支撑喉镜下声带息肉摘除术应用瑞芬太尼麻醉的临床观察

目的 对比观察芬太尼与瑞芬太尼麻醉用于支撑喉镜下行声带息肉摘除术患者的应激反应及患者苏醒情况. 方法 选择86例ASAⅠ～Ⅱ级择期声带息肉摘除术患者,随机均分为两组,即芬太尼组(F组)和瑞芬太尼组(R组).F组诱导及维持麻醉用芬太尼;R组诱导及维持麻醉用瑞芬太尼.两组患者置入支持喉镜成功后,均用喷射呼吸机行常频喷射通气.监测围术期各时点的收缩压(SBP)、舒张压(DBP)、心率(HR)、动脉氧分压(SpO2),记录麻醉时间及患者清醒时间,统计麻醉质量及患者苏醒时的不良反应. 结果 F组放置支持喉镜后SBP、DBP、HR明显升高(P<0.01);清醒时间F组明显长于R组(P<0.01);F组术后恶心、呕吐发生率高于R组(P<0.05). 结论 瑞芬太尼用于声带息肉摘除术患者的麻醉应激反应小,患者苏醒迅速、苏醒时不良反应少. Abstract： Objective To compare the patients'stress reaction and palinesthesia of anesthesia with remifentanil and fentanyl in excision of polyp of vocal cord under self-retaining laryngoscope. Methods Eighty-six ASAⅠ-Ⅱ patients scheduled for polyp of vocal cord under self-retaining laryngoscope were randomly divided into two groups: fentanyl group (group F,n=43) and remifentanyl group (group R,n=43).Group F were induced with fentanyl,modazolam,propofol and succinylcholine chloride,maintained with fentanyl,propofol and succinylcholine chloride,while group R with remifentanil instead of fentanyl. The changes of SBP,DBP,MAP,HR, SpO2 were checked at different time point surround the operation. We recorded the anesthetize time and awake time, the quality of the anesthesia and side-effect of palinesthesia.Results The SBP,DBP,MAP and HR of group F were increased obviously after place self-retaining laryngoscope (P<0.01);The recovery time of group F was longer than that of group R (P<0.01);The incidences of postoperative nausea and vomit in group F were slightly higher than those in group R (P<0.05).Conclusions Compared with fentanyl,remifentanil can be used more safely and effectively in polypectomy of vocal cord.     

抑肽酶对减轻非体外循环冠状动脉旁路移植术心肌损伤的影响

目的　观察抑肽酶对非体外循环冠状动脉旁路移植术心肌损伤的影响。方法　将 2 4例非体外循环冠状动脉旁路移植术患者随机分为两组 :抑肽酶组 (12例 )和对照组 (12例 )。抑肽酶组给予抑肽酶 2× 10 6 KIU在诱导后 30min内静脉输注 ,然后 0 5× 10 6 KIU h静脉输注维持至术毕。测量麻醉诱导后、冠状动脉血管吻合后 1h、术后 6h以及术后 2 4h各时间点肺动脉血中心肌损伤指标肌酸激酶同工酶 (CK MB)和肌钙蛋白Ⅰ (cTnI) ;记录术中自体血液回收量和术后即刻、术后 6h内和术后 2 4h内伤口引流量。结果　CK MB和cTnI在两组内于吻合后均明显升高 ,抑肽酶组心肌损伤指标cTnI在术后 6h和 2 4h均低于对照组 (P <0 0 5 ) ;抑肽酶组术后纵隔胸腔引流量在术后 6h内和 2 4h内均明显低于对照组 (P <0 0 5 )。结论　抑肽酶可以减轻非体外循环冠状动脉旁路移植术导致心肌损伤。     

不同浓度瑞芬太尼对地氟醚最低肺泡有效浓度的影响

目的:观察不同浓度瑞芬太尼对地氟醚最低肺泡有效浓度(MAC)的影响。方法:以脑电双频谱指数(BIS)=50作为指标来确定地氟醚的ED50值(MACBIS50),将80例患者鼓室成形术随机分为A、B、C、D、E5组(每组16例),接受瑞芬太尼静脉输注靶控血浆浓度分别为0,2,4,6,8ng/ml。患者术前用阿托品0.01mg/kg肌肉注射,全麻诱导采用咪达唑仑0.02mg/kg,异丙酚2mg/kg,维库溴铵0.1～0.2mg/kg。诱导插管后按靶控血浆浓度泵控输注瑞芬太尼并吸入地氟醚,待地氟醚呼气末浓度(ET%)达到预定值并稳定10min后,手术切皮并记录相应的BIS值。采用上下波动法分别计算各组的地氟醚MACBIS50,BIS值和ET%进行直线回归分析。结果:5组患者地氟醚MACBIS50值分别为7.18%,6.31%,4.18%,2.86%和2.19%。与A组比较,其余4组的MACBIS50显著降低(P<0.05)。各组BIS和ET%直线相关。结论:瑞芬太尼复合地氟醚麻醉可显著降低地氟醚MAC,并呈剂量依赖性降低,瑞芬太尼超过8ng/ml时,下降速度趋缓,逐渐出现封顶效应。并保持BIS值和呼气末浓度的直线相关性。     

75岁以上高龄患者非体外循环下冠脉旁路移植术的远期疗效

目的：分析75岁以上高龄患者行非体外循环下冠脉旁路移植术（OPCAB）的远期疗效及其危险因素。方法2000年11月~2013年11月,97例75岁以上高龄患者由同一术者完成非体外循环下冠脉旁路移植术。统计重症监护病房（ICU）时间、机械通气时间、术后并发症发生率及死亡率等围术期结果。出院后随访包括全因死亡及主要心脑血管不良（MACCE）事件（心肌梗死、脑血管事件、重复再血管化）。结果围术期死亡3例,在院死亡率3%,随访成功率93.81%,随访时间为（29-192）（95.61±34.07）个月。10年生存率为62%,10年MACCE事件免除率为47.4%。随访期间6例（6.8%）患者进行了重复再血管化,12例（12.37%）患者出现脑血管事件,5例（5.15%）出现心梗。Logistic回归分析显示术前合并高血压（OR=1.388,P=0.043）、糖尿病（OR=1.692,P=0.017）是高龄患者OPCAB术后远期MACCE事件的独立风险预测因素,而不完全再血管化并不会增加术后主要心脑血管不良事件（MACCE）事件发生率。结论高龄冠心病患者行非体外循环下冠脉旁路移植术是一种安全有效的手术方法,远期效果满意。高血压、糖尿病是高龄患者OPCAB术后发生MACCE事件的危险因素,但术后良好地控制血压及血糖可以有效降低MACCE事件的发生率,而不完全再血管化并不会对远期疗效产生不良影响。     

Off-pump coronary artery bypass (OPCAB) in southern Mississippi

Off-Pump Coronary Artery Bypass (OPCAB) allows myocardial revascularization without use of cardiopulmonary bypass and may be associated with fewer postoperative complications. A retrospective review was undertaken to assess the value of this new strategy in our surgical practice. The records of all our patients (n = 259) undergoing isolated coronary artery bypass (CAB) operations from January 1 through December 31, 1999, were reviewed (Table 1). Patient characteristics and comorbidities were similar in both groups with the exception of age and diabetes (Table 2). Mean operating room time, blood products transfused, morbidity, mortality, and length of stay (LOS) were all significantly less in the OPCAB group. We conclude that OPCAB techniques may offer significant benefits to our population of patients undergoing myocardial revascularization.     

骨髓细胞移植联合激光心肌血运重建及冠状动脉旁路移植术治疗缺血性心脏病

本研究在常规再血管化治疗的基础上,联合应用细胞移植和激光心肌血运重建术(transmyocardial laser revascularization,TMLR)治疗,以期进一步改善终末期缺血性心肌病患者的心肌供血,提升心脏功能,并对联合术式的围术期安全性及其早期临床疗效进行探讨.     

Effect of remifentanil on toll-like receptor 4, NF-κB and IL-6 in rabbit myocardial ischemia/reperfusion model

Objective:To investigate whether remifentanil induced cardioprotecting effect is associated with expression of toll-like receptor 4 (TLR4).nuclear factor κB (NF-κB) and serum interleukin -6 (IL-6).Meth...     

无痛人工流产术中予以丙泊酚复合芬太尼、舒芬太尼、瑞芬太尼的效果

目的 探讨无痛人工流产术中予以丙泊酚复合芬太尼、舒芬太尼、瑞芬太尼的效果。方法 选择2019年3月至2020年3月我院收治的78例无痛人工流产术患者进行分组研究,以随机数字表法分为三组,每组各26例,包括芬太尼组(丙泊酚复合芬太尼)、舒芬太尼组(丙泊酚复合舒芬太尼)、瑞芬太尼组(丙泊酚复合瑞芬太尼),比较三组丙泊酚用量、清醒时间、清醒时VAS评分、清醒1 h后VAS评分及不良反应发生率。结果 瑞芬太尼组丙泊酚用量为(95.64±15.67)mg,明显低于芬太尼组的(119.04±12.64)mg与舒芬太尼组的(120.38±17.32)mg,差异有统计学意义(P0.05),但三组患者清醒时间、清醒时VAS评分比较,差异无统计学意义(P0.05),舒芬太尼组清醒1 h后VAS评分(4.01±1.24)分,明显低于芬太尼组的(5.20±0.85)分与瑞芬太尼组的(5.22±0.78)分,差异有统计学意义(P0.05);三组患者低血压率、心动过缓率比较,差异无统计学意义(P0.05);但瑞芬太尼组低氧血症率为26.92%,明显高于芬太尼组(7.69%)与舒芬太尼组(3.85%),差异有统计学意义(P0.05)。结论 无痛人工流产术中予以丙泊酚复合芬太尼、舒芬太尼、瑞芬太尼均有不错的效果,但舒芬太尼安全性好,镇痛效果较好。     

Myocardial injury during off-pump surgery. The effect of intraoperative risk factors

OBJECTIVE: To achieve better outcomes, the degree of myocardial injury due to off-pump coronary artery bypass surgery (OPCAB) must be reduced. We studied the factors that render patients scheduled for OPCAB vulnerable to myocardial injury, using troponin T (cTnT) as a marker of myocardial injury. METHODS: We prospectively investigated 123 patients being operated by a group of surgeons with off-pump technique between January 2001 and June 2006 in Siyami Ersek Thoracic and Cardiovascular Surgery Center. Myocardial injury occurring during surgery was assessed by post-operative cTnT measurement. Then, the relation between intraoperative factors and postoperative cTnT release were statistically evaluated. RESULTS: Blood samples for cTnT measurement were taken from all patients before operation, immediately after arrival at the intensive care unit, then at 6, 12, and 24 hours after distal revascularization. When regarding the intraoperative risk factors, we found that the heart rate, blood pressure and anastomosis time are the main determinant of myocardial cell injury occurring during OPCAB surgery. CONCLUSION: Although aortic cross-clamp and cardioplegic arrest were not used in off-pump myocardial revascularization, the ischemic myocardial cell destruction was also inevitable in off-pump technique. Therefore, management of heart rate and myocardial contractility was desirable not only for precise anastomosis but also for myocardial protection during OPCAB surgery.     

乌司他丁对非体外循环冠状动脉旁路移植术患者心肌损伤的保护作用

目的 观察乌司他丁对非体外循环冠状动脉旁路移植术（OPCAB）患者围术期心肌损伤的影响。方法采取随机、双盲、对照的方法将24例OPCAB患者分为对照组（C组）和乌司他丁组（W组）,每组12例。W组：麻醉诱导后开始恒速静脉泵入6000U／kg的乌司他丁,30min输完,然后以1000U·kg^-1·h^-1的速度持续静脉泵入至手术结束。C组：给予同样容积的生理盐水。分别在切皮前（T1）、冠状动脉血管全部吻合结束后0．5h（T2）、术后2h（T3）、6h（T4）、18h（T5）采集患者血浆测定肌钙蛋白I（cTnI）浓度,并记录患者的临床资料。结果 C组和W组cTnⅠ值从术后2h至术后18h各时点均较切皮前显著升高（P〈0．01）。w组cTnⅠ值从血管吻合后0．5h至术后18h各时点均较C组显著降低（P〈0．05）。结论 乌司他丁可以降低OPCAB患者围术期cTnⅠ水平,对心肌损伤具有一定的保护作用。     

Comparative study of on-pump and off-pump coronary bypass surgery in patients with triple-vessel coronary artery disease

Background Studies on selected patients undergoing off-pump versus on-pump coronary artery bypass surgery have produced inconsistent results, especially in patients with multiple coronary artery disease. This study compared the clinical results of on-pump and off-pump coronary bypass surgery in patients with triple-vessel disease.Methods A total of 300 consecutive isolated, multiple coronary artery bypass grafting (CABG) patients were assigned to the off-pump coronary artery bypass (OPCAB, n=150) or CABG with cardiopulmonary bypass (CCABG, n=150) groups. There were no significant differences regarding degree of angina, history of myocardial infarction or diabetes, and presence of left main coronary artery disease between the two groups. Ejection fraction in the OPCAB group before surgery was lower than in the CCABG group (P&lt;0.01). In addition, more patients had a history of stroke and abnormal renal function preoperatively in the OPCAB group（P&lt; 0.01）. In OPCAB patients, single deep pericardial stay suture with a sling snared down was used to expose the target vessels, along with a stabilizer and a coronary shunt. A Medi-Stim Butterfly Flowmeter was used to measure blood flow through grafts in both groups.Results No OPCAB patient was converted to the CCABG group. The average numbers of distal anastomoses and the indexes of completeness of revascularization (ICR) were similar in both groups. Postoperative respiratory support time and the volumes of chest tube drainage and of blood transfusions were less in the OPCAB group than in the CCABG group (both P&lt;0.01). The postoperative incidences of pulmonary dysfunction and renal insufficiency were lower in the OPCAB group than in the CCABG group （both P&lt;0.05）. There were no significant differences between the two groups in mortality and other causes of morbidity (periopetative myocardial infarction, stroke, atrial fibrillation). Conclusions OPCAB can be applied to patients with triple-vessel coronary artery disease and can achieve similar completeness of revascularization and similar early surgical results, with shorter respiratory support, reduced transfusion requirement, and fewer cases of pulmonary dysfunction and abnormal renal function.