不停跳冠状动脉旁路移植手术中的内皮素变化

目的 检测不停跳冠状动脉旁路移植(OPCAB)术中、术后不同时段不同部位血浆内皮素水平,观察手术中各个循环内皮素水平的变化.方法 30例冠心病患者分为两组.A组15例,男13例,女2例,年龄(57.4±8.25)岁]使用左乳内动脉+大隐静脉移植;B组15例,均为男性,年龄(50.50±7.05)岁]进行全动脉化移植.手术中各桥血管移植前后,分别取冠状静脉、肺动脉、桡动脉血,检测内皮素水平.术后2、24 h分别取肺动脉、桡动脉血,检测内皮素水平.结果 A组,手术中冠状静脉(34.31±15.10)ng/L、肺动脉(35.79±18.89)ng/L、桡动脉(34.65±15.62)ng/L]血内皮素无显著升高;手术后2 h,肺动脉(45.93±20.58)ng/L、桡动脉(52.68±21.46)ng/L血明显升高;手术后24 h,肺动脉(39.21±23.39)ng/L、桡动脉(33.31±21.54)ng/L血下降至术前水平.B组,搭桥前、左乳内动脉搭桥开放后,冠状静脉(36.77±21.45)ng/L、肺动脉(35.50±24.39)ng/L、桡动脉(33.17±20.80)ng/L血内皮素无明显变化;在剩余移植桥开放后,冠状静脉(52.00±20.86)ng/L、肺动脉(48.84±23.26)ng/L、桡动脉(49.66±21.22)ng/L血显著升高.术后2、24 h,肺动脉(52.52±30.34)ng/L、桡动脉(53.72±33.42)ng/L血维持高水平.结论 OPCAB会引起血浆内皮素水平小幅升高.全动脉与乳内动脉+大隐静脉比较术中血浆内皮素升高较早持续时间较长.

Change of plasma endothelin levels during off-pump coronary artery bypass

Objective To determine the changes of plasma endothelin level during and after off-pump coronary artery bypass (OPCAB). Methods Thirty patients submitted for elective OPCAB were in-cluded in a prospective, randomized study. Fifteen patients (13 males,2 females, age 57.4±8.25 years) were subjected to left internal mammary artery (LIMA) and saphenous vein grafts (SV), and 15 patients (15 males,age 50.50±7.05 years) to total artery grafts. Plasma levels of endothelin from coronary vein, pulmonic artery and radial artery were measured before and during surgery and 2,24 h after surgery. Re-salts Endothelin concentrations were higher early after surgery and recovered in 24 h after surgery from (35.79±18.89),(34.65±15.62) ng/L to (45.93±20.58),(52.68±21.46) ng/L to (39.21± 23.39), (33.31±21.54) ng/L] in the patients undergoing LIMA and SV grafts. Plasma levels of eudo-thelin were increased after all grafts opened in the patients subject to total artery grafts,and the high plas-ma levels of endothelin were persisted in 24 h after surgery from (36.77±21.45), (35.50±24.39), (33.17±20.80) ng/L to (52.00±20.86), (48.84±23.26), (49.66±21.22) ng/L to (52.52± 30.34), (53.72±33.42) ng/L]. Conclusion OPCAB can cause the slight increase in the plasma en-dothelin concentration. In comparison to those in patients subject to LIMA + SV grafts, plasma endothelin levels in patients receiving total artery grafts were increased earlier and kept longer.