Safety of oral nicorandil before coronary artery bypass graft surgery

Nicorandil is a K_ATP channel opener used to treat angina. Itis cardioprotective and a vasodilator. We conducted a prospective,randomized, double-blind, placebo-controlled study to assessoral nicorandil in patients undergoing coronary artery bypassgrafting (CABG) with cardiopulmonary bypass (CPB). Twenty-twopatients received nicorandil (10 mg twice a day) and 23patients received placebo. Haemodynamic data were recorded beforeinduction of anaesthesia (T0), 5 and 20 min after startingmechanical ventilation (T1, T2), before aortic cannulation (T3),after 30 min of CPB (T4), 10 min after CPB (T5) andafter 3, 8 and 18 h in the intensive care unit (T6, T7,T8). Serum proteins (creatine kinase metabolite and cardiactroponin I) were measured before and 8 and 18 h after surgery.Haemodynamic values did not differ between the two groups. Therewas no tachycardia during the study, no significant differencein hypotensive episodes, ST segment changes and no changes incardiac enzymes. Myocardial infarction after surgery was similarin the two groups. Vasoactive therapy was similar in the twogroups. Nicorandil can be continued safely up to premedicationwithout deleterious haemodynamic consequences, but a myocardialprotective effect of nicorandil in CABG surgery was not found. Br J Anaesth 2001; 87: 848–54     

Predictors of atrial fibrillation after off-pump coronary artery bypass graft surgery

Background: Postoperative atrial fibrillation (AF) is one of the most commoncomplications after cardiothoracic surgery and is associatedwith an increased risk of stroke, and longer hospital stay.The pathophysiology of postoperative AF is uncertain, and itsprevention remains unsatisfactory. Many previous studies haveexamined the predictors of AF after on-pump coronary arterybypass graft surgery (CABG), but there are few reports afteroff-pump CABG. Methods: The aim of the present prospective observational study, in which296 consecutive patients were enrolled, was to elucidate thepredictors of AF after off-pump CABG. The association of perioperativefactors with AF was investigated using univariate analysis.Significant variables were included into a stepwise logisticregression model to ascertain their independent influence onthe occurrence of AF. Results: The incidence of AF was 32%. AF prolonged the time until patientswere fit for discharge by 3 days (P < 0.01). Stepwise multivariateanalysis identified increasing age [odds ratio (OR) 1.44 per10-yr increase; 95% confidence interval (CI) 1.06–1.95],intraoperative average core temperature (OR 1.64; 95% CI 1.05–2.56),the average cardiac index in the intensive care unit (OR 0.37;95% CI 0.19–0.71), and intraoperative fluid balance (OR0.96 per 100-ml increase; 95% CI 0.93–0.99) as independentpredictors of postoperative AF. Conclusion: Our present findings indicate that ageing, the intraoperativefluid balance, and postoperative cardiac index are associatedwith the onset of AF after off-pump CABG.     

Haemodynamic effects of heparin during coronary bypass surgery

Heparin has been suggested as an activator of the plasma kallikrein-kinin system, with possible formation of bradykinin, a potent vasodilator. Haemodynamic effects and changes in the kallikrein-kinin system were studied after heparin- and saline-injections in ten patients undergoing coronary bypass surgery. A moderate decrease in mean arterial pressure was found in all patients in the observation period, but significantly more at 2 and 3 min after heparin-injection compared with saline-injection. None of the other haemodynamic variables measured were significantly different when comparing heparin- to saline-injection. Heparin-injection resulted in significant changes in the kallikrein-kinin system, with a marked increase in spontaneous kallikrein-like activity as the most prominent feature, while no changes were found after saline-injection. Liberation of bradykinin would be expected to give a decrease in systemic vascular resistance with an increase in cardiac output. The results indicate that the plasma kallikrein-kinin system, though apparently activated after heparin-injection, does not contribute significantly to the decrease in arterial pressure in the patients studied.     

Haemodynamic effects of a milrinone infusion without a bolus in patients undergoing off-pump coronary artery bypass graft surgery

The haemodynamic effects of a continuous infusion of milrinone without an initial bolus dose were evaluated in patients undergoing off-pump coronary artery bypass graft surgery. After internal mammary artery harvest, milrinone 0.5 microg.min(-1).kg(-1) (29 patients) or a normal saline infusion (33 patients) was started and continued until all graft anastomoses were completed. Haemodynamic variables were recorded before application of the tissue stabiliser, at 1, 3, 5 and 10 min after the application of the stabiliser, and after its removal. The administration of a milrinone infusion was associated with a smaller decrease in cardiac output and mixed venous oxygen saturation during all the coronary artery anastomoses, with no severe complications and a decreased dose of norepinephrine infused to maintain systemic arterial pressure.     

Fenoldopam: renal and splanchnic effects in patients undergoing coronary artery bypass grafting

Impairment of renal and splanchnic perfusion during and after cardiopulmonary bypass may be responsible for acute renal failure and endotoxin-mediated systemic inflammation, respectively. We hypothesised that fenoldopam, a selective dopamine receptor agonist, would preserve renal function after cardiopulmonary bypass through its selective renal vasodilatory and natriuretic effects, and increase gastrointestinal mucosal perfusion by selective splanchnic vasodilation. We examined the effects of fenoldopam on haemodynamic parameters, creatinine clearance, fractional excretion of sodium, urine output, free water clearance and gastric mucosal pH in 31 patients undergoing elective coronary revascularisation. Patients were randomly assigned to receive continuous infusions of fenoldopam 0.1 microg x kg(-1) x min(-1) (n = 16) or placebo (n = 15). Renal parameters were measured: during a 24-h period before hospital admission, during cardiopulmonary bypass, from completion of cardiopulmonary bypass until 4 h later, from 4 to 8 h after cardiopulmonary bypass, and from 8 to 14 h after cardiopulmonary bypass. Gastric intramucosal pH was measured using a gastric tonometer before, during and after cardiopulmonary bypass. In the placebo group, but not the fenoldopam group, mean (SD) creatinine clearance decreased after separation from cardiopulmonary bypass, from 107 (36) to 71 (22) ml x min(-1) (p < 0.01) and from 107 (36) to 79 (26) ml x min(-1) (p < 0.01) for the 0-4 h and 4-8 h intervals after cardiopulmonary bypass, respectively. Changes in intramucosal pH were similar in both groups. The findings are consistent with the hypothesis that fenoldopam possesses a renoprotective effect in patients undergoing cardiopulmonary bypass.     

Impact of off-pump coronary artery bypass surgery on postoperative renal dysfunction: current best available evidence

SUMMARY:   Renal dysfunction is a serious complication after coronary artery bypass surgery with cardiopulmonary bypass. Cardiopulmonary bypass-related non-pulsatile flow, hypothermia, haemolysis, systemic inflammatory reactions and emboli are mentioned as possible causes for this postoperative renal dysfunction. In an attempt to avoid these deleterious effects of cardiopulmonary bypass, off-pump coronary artery bypass surgery has been rediscovered. Resurgence of interest in off-pump coronary artery bypass surgery is associated with the expectation that avoiding deleterious effects of the cardiopulmonary bypass leads to better outcomes and possibly decreased costs and resource use. We are currently practising in an era of evidence-based medicine that mandates the prospective randomized controlled trial as the most accurate tool for determining a treatment benefit compared with a control population. The present review article attempts to evaluate the current best available evidence from randomized controlled trials on the impact of off-pump coronary artery bypass surgery on postoperative renal dysfunction.     

Silent left ventricular dysfunction during exercise after coronary artery bypass surgery

Serial changes in left ventricular function during exercise were assessed by radionuclide continuous ventricular function monitoring in 80 patients undergoing coronary artery bypass surgery before and after operation. This monitor records serial beat by beat radionuclide and electrocardiographic data and calculates the left ventricular ejection fraction every 20s. The profiles of ejection fractions during graded bicycle exercise were divided into 4 types. In type A, the ejection fraction continued to increase. In type B, the ejection fraction initially increased but decreased in late exercise. In type C, the ejection fraction did not change. In type D, the ejection fraction continued to decrease. Type A is considered to be the normal response to exercise and types B, C and, D are considered to be abnormal responses. Before operation, 8 patients showed type A, 21 type B, 13 type C, and 38 type D. After operation, 53 patients showed type A, 16 type B, 8 type C, and 3 type D. The mean ejection fraction decreased with exercise from 53%±11% to 47%±11% before surgery, but increased with exercise from 55%±10% to 64%±14% after surgery. During postoperative exercise, no patient developed chest pain but 19 patients showed a decrease in the ejection fraction in early or late exercise. A decrease in the ejection fraction is an earlier indicator of myocardial ischaemia than angina or electrocardiographic changes. Silent left ventricular dysfunction during postoperative exercise was considered to reflect myocardial ischaemia resulting from occluded grafts, ungrafted coronary arteries, or inadequate perfusion by arterial grafts. The radionuclide continuous ventricular function monitor can detect silent left ventricular dysfunction after coronary artery bypass surgery.     

Haemodynamic effects of nifedipine in patients undergoing coronary artery bypass surgery

Forty patients scheduled for elective aortocoronary bypass surgery were entered in a double-blind study set up to compare the haemodynamic effects of 20 mg nifedipine (n = 20) and placebo (n = 20), both administered with the premedication. Global left ventricular function was normal in all patients. Anaesthesia was induced and maintained with standardized doses of fentanyl, flunitrazepam, and pancuronium together with 50% N2O. Cardiovascular responses to anaesthesia, intubation, skin incision, sternal retraction, and aortic manipulation were investigated. Throughout the study nifedipine produced a marked decrease in systemic vascular resistance. The reduction of left ventricular afterload was associated with an increase in cardiac index. In contrast to other reports, we observed no severe hypotension after nifedipine administration. Mean arterial pressure in patients from the nifedipine group was lower than in the placebo group only prior to anaesthesia. Since no negative drug interactions between nifedipine and the anaesthetic agents were observed, we conclude that the established cardiovascular benefit of nifedipine should be continued during anaesthesia.     

Acute renal failure in patients with pre-existing renal dysfunction following coronary artery bypass grafting

BACKGROUND: Pre-existing renal dysfunction predisposes to acute renal failure (ARF) in patients undergoing coronary artery bypass grafting. We assessed the incidence and impact of the development of ARF in this patient population in our unit. METHODS: One-hundred and six patients had a preoperative serum creatinine of >or=0.13 mmol/L and underwent coronary artery bypass grafting in the year 2000. The incidence of ARF (as defined by a >or=50% rise in postoperative serum creatinine), hospitalization days, dialysis requirement, in-hospital and 1-year mortality, and potential risk factors for ARF were recorded. RESULTS: Of the patients recorded, 43/104 (41.35%) developed ARF following coronary artery bypass grafting. Patients with ARF stayed in hospital longer (P < 0.02). Ten out of forty-three patients required some form of dialysis and the in-hospital mortality of the renal failure group was 23% compared to 3.1% in the other group (P < 0.002). One year postoperatively, the group with renal failure had significantly worse survival (71.8% vs 98%P < 0.0001). CONCLUSION: For patients undergoing coronary artery bypass grafting, pre-existing renal dysfunction predisposes to the development of ARF, this is associated with prolonged hospitalization and increased mortality.     

Lack of renoprotective effect of i.v. N-acetylcysteine in patients with chronic renal failure undergoing cardiac surgery

Background. Pre-existing chronic renal failure is a significantrisk factor for acute renal failure (ARF) after cardiac surgery.N-acetylcysteine (NAC) has been shown to prevent contrast media-inducedARF. Our objective was to evaluate whether i.v. NAC has renoprotectiveeffects in patients with mild renal failure undergoing cardiacsurgery. Methods. In this prospective, randomized, double-blind study,80 patients with mild to moderate renal failure undergoing electiveheart surgery with cardiopulmonary bypass were recruited. Allreceived either i.v. NAC (n=38) or placebo (n=39) at inductionof anaesthesia and then up to 20 h. Urine N-acetyl-ß-D-glucosaminidase(NAG) and urine creatinine ratio, plasma creatinine, and serumcystatin C levels indicated renal function. Results. Levels of urinary NAG/creatinine ratio, plasma creatinineand serum cystatin C did not significantly differ between NACand placebo groups during five postoperative days. Urine NAG/creatinineratio increased over 30% in 100% of patients in the NAC groupvs 92.3% in the placebo group (P=0.081). Plasma creatinine increasedby 25% from baseline or over 44 µmol litre^–1 in42.1% in NAC group vs 48.7% in placebo group (P=0.560). Serumcystatin C exceeded 1.4 mg litre^–1 in 78.9% in NAC groupvs 61.5% in placebo group (P=0.096). Conclusions. Prophylactic treatment with i.v. N-acetylcysteinehad no renoprotective effect in patients with pre-existing renalfailure undergoing cardiac surgery.     

Endogenous stem cells in patients undergoing coronary artery bypass graft surgery

Considerable research efforts have recently been made towards the application of autologous stem cell therapy for cardiovascular regeneration. Patients with coronary artery disease undergoing surgery represent a potential target. As yet, this approach has failed to obtain satisfactory evidence in clinical studies. However, several observational studies have described mobilising effect of cardiac surgery on endogenous stem cells, although the mechanisms of this phenomenon and its clinical relevance are not defined. This article reviews available clinical data on the effect of cardiac surgery on endogenous stem cells and outlines some of the controversies in this area.     

Increased risk associated with combined carotid endarterectomy and coronary artery bypass graft surgery: a propensity-matched comparison with isolated coronary artery bypass graft surgery

OBJECTIVE: Risk associated with combined carotid endarterectomy and coronary artery bypass graft surgery (CEA/CABG) is controversial. The present study objective was to compare morbidity and mortality outcomes in well-matched patients who underwent combined CEA/CABG surgery with patients undergoing isolated CABG surgery with and without a history of a prior CEA. DESIGN: This investigation was designed as a retrospective case-controlled study using data from the Cardiothoracic Anesthesia Patient Registry in a single tertiary institution. The patient population consisted of 1,698 isolated CABG surgery patients with carotid artery stenosis >40%, 708 patients who underwent an isolated CABG surgery but had a history of a prior CEA, and 272 combined CEA/CABG surgery patients who underwent surgery from January 4, 1993, through June 30, 2003. Propensity modeling techniques were used to calculate a propensity score for each patient. Greedy matching resulted in 272 propensity-matched pairs of combined CEA/CABG and isolated CABG patients (primary analysis) and 241 propensity-matched pairs of combined CEA/CABG surgery and isolated CABG surgery with previous CEA patients (secondary analysis). A Fisher exact, chi-square, Wilcoxon rank sum, and Student t test were applied appropriately to compare the propensity-matched pairs. RESULTS: The distribution of covariates among the propensity-matched combined CEA/CABG and isolated CABG groups were similar. Among the propensity-matched pairs in the primary analysis, overall morbidity and mortality were higher in the combined CEA/CABG group compared with the CABG group alone (overall morbidity 15% v 8.8%, p = 0.025, and mortality 5.2% v 1.1%, p = 0.007, respectively). Median intensive care unit (ICU) length of stay was longer (47 v 31 hours, p = 0.004) and hospital length of stay was longer (12 v 9 days, p < 0.001) for the combined CEA/CABG surgery compared with isolated CABG surgery, respectively. Postoperative cardiac, neurologic, serious infection, and renal morbid events were similar between the 2 groups. In the secondary analysis, the rates of mortality, overall morbidity, and neurologic morbidity were similar between the groups, whereas the median ICU and hospital length of stay were significantly longer in the combined CEA/CABG group (47.6 v 39.8 hours, p = 0.025, and 12.0 v 9.0 days, p < 0.001, respectively). CONCLUSIONS: Increased mortality and overall morbidity outcomes were found in the combined CEA/CABG group when compared with well-matched isolated CABG patients, but similar when compared with well-matched isolated CABG patients with a history of previous CEA. Patients undergoing combined CEA/CABG procedures had significantly longer ICU and hospital lengths of stay compared with patients undergoing isolated CABG procedures.     

The effects of propofol on neutrophil function, lipid peroxidation and inflammatory response during elective coronary artery bypass grafting in patients with impaired ventricular function

Background. Coronary artery bypass grafting (CABG) with cardiopulmonarybypass elicits a potent reperfusion injury and inflammatoryresponse, more intense in patients with impaired myocardialfunction. Propofol has antioxidant properties which may attenuatesuch a response. Methods. In total, 27 patients with impaired left ventricularfunction undergoing CABG were randomly allocated to receiveeither target-controlled infusion propofol (P) or saline (S)immediately before aortic cross-clamp release until 4 h afterreperfusion. Troponin-I, Urinary 8-epi PGF-2 isoprostane, coronarysinus and systemic malondialdehyde concentrations, Interleukin-6(IL-6), -8 and -10 concentrations and leucocytes function studies(neutrophil respiratory burst, phagocytosis, CD-11b and CD-18expression) were measured. Results. Propofol decreased MDA coronary sinus concentrationat 1, 3 and 5 min after reperfusion (P<0.01); 60 min afterreperfusion a significant difference between the two groupsin systemic MDA concentrations was also seen. IL-6 concentrationincreases were significantly greater in Group S than Group P,4 h after reperfusion [1118 (1333) pg ml^–1 vs 228 (105)pg ml^–1, P<0.01]. Serum IL-8 concentrations did notincrease significantly in either group. Compared with baselinevalues IL-10 concentrations decreased after reperfusion butthe values were higher in the propofol group than in the controlgroup [22 (16) vs 11 (4) pg ml^–1, P<0.05]. No differencein leucocyte function or urinary isoprostane concentrationswas demonstrated. Conclusion. Propofol attenuates free-radical-mediated lipidperoxidation and systemic inflammation in patients with impairedmyocardial function undergoing CABG.     

乌司他丁对非体外循环冠状动脉旁路移植术病人围术期炎性反应的影响

目的观察乌司他丁对非体外循环冠状动脉旁路移植术(OPCABG)病人围术期炎性反应的影响。方法拟行OPCABG的病人24例,采用随机、双盲方法分为对照组(C组)和乌司他丁组(U组),每组12例。静脉注射咪达唑仑0.1mg/kg、芬太尼10～20μg/kg、哌库溴铵0.1mg/kg麻醉诱导后气管插管,机械通气,吸入1%～2%异氟烷、间断静脉注射芬太尼(2～5μg/kg,总量最高为50μg/ kg)、持续静脉输注哌库溴铵0.03～0.05mg·kg~(-1)·h~(-1)维持麻醉。U组麻醉诱导后开始恒速静脉输注乌司他丁6 000U/kg(30min内输完),然后以1 000 U·kg~(-1)·h~(-1)的速率持续静脉输注至手术结束。C组采用的同样方法输注等容量的生理盐水。分别在切皮前即刻(T_1)、冠状动脉全部吻合结束后0.5h (T_2)、术后2h(T_3)、6h(T_4)、18h(T_5)采集静脉血,测定血浆白细胞介素-6(IL-6)、IL-10、终末补体复合物(TCC)的浓度及CD11b/CD18的表达。结果与T_1比较,C组在T_(3,4)时IL-6浓度、T_3时IL-10浓度升高,T_(2-4)时CD11b/CD18表达升高,2组在T_2时TCC浓度均升高(P<0.05或0.01);与C组比较,U组在T_3时IL-6、IL-10浓度降低,在T_(2～4)时CD11b/CD18表达降低(P<0.05或0.01)。结论乌司他丁可在一定程度上抑制OPCABG病人围术期IL-6、IL-10浓度及CD11b/CD18表达的升高,具有减轻炎性反应的作用。     

Haemodynamic changes during induction of anaesthesia with midazolam and diazepam (Valium) in patients undergoing coronary artery bypass surgery

Midazolam 0.3 mg/kg and diazepam 0.5 mg/kg were used for induction of anaesthesia in two groups of 10 patients each undergoing coronary artery bypass surgery. Haemodynamic variables were measured during induction of anaesthesia, after pancuronium and following tracheal intubation. Haemodynamic indices were derived from these measurements using standard formulae. The induction of anaesthesia with midazolam produced a slight but significant increase in heart rate. There was a significant fall in systemic arterial pressure and pulmonary artery pressure following both drugs. Despite the fall in systemic arterial pressure, the cardiac index was maintained in patients who received midazolam. The cardio-stimulatory effect of laryngoscopy and tracheal intubation was not prevented by either of the benzodiazepines and morphine in the dosage used. Midazolam is a suitable alternative to diazepam as part of an intravenous induction regimen in patients with ischaemic heart disease.     

Continuous cardiac output during off-pump coronary artery bypass surgery: pulse-contour analyses vs pulmonary artery thermodilution

Background: No gold standard method exists for monitoring continuous cardiacoutput (CO). In this study, the agreement between the two mostfrequently used methods, PiCCO pulse-contour analysis (PCCO)and STAT pulmonary artery thermodilution (STAT-CO), was assessedduring multiple-vessel off-pump coronary artery bypass (OPCAB)surgery. Methods: Thirty patients were enrolled in the study. Two time periodswere defined during surgery; Period 1 included positioning ofthe heart and stabilizer device and Period 2 included the coronaryocclusion. Measurements were obtained every minute during bothperiods. The agreement for the continuous CO and the changein CO (CO) was estimated using the Bland–Altman method. Results: Significant changes in mean arterial pressure (MAP), centralvenous saturation, PCCO and STAT-CO were seen only during Period1. MAP correlated only with changes in PCCO, (P < 0.001,r = 0.60). The mean difference (2SD) between PCCO and STAT-COranged from – 0.29 (1.82) to – 0.71 (2.57) litremin^–1, and the percentage error varied from 32 to 50%.For the CO measurements, the limits of agreements did not differbetween Period 1 and Period 2. In contrast, for the CO measurements,the limits of agreements were wider in Period 1 than in themore haemodynamically stable Period 2. Conclusions: PCCO and STAT-CO show large discrepancies in CO during OPCABsurgery. Clinically acceptable agreement was seen only for trendsin CO during haemodynamically stable periods.     

Prophylactic dialysis in patients with renal dysfunction undergoing on-pump coronary artery bypass surgery

BACKGROUND: Preoperative creatinine values higher than 2.5 mg/dL are associated with markedly increased risk for both mortality and morbidity in patients undergoing coronary artery bypass surgery. We aimed to determine the effects of prophylactic perioperative hemodialysis on operative outcome in patients with nondialysis-dependent moderate renal dysfunction. METHODS: Forty-four adult patients with creatinine levels greater than 2.5 mg/dL but not requiring dialysis underwent coronary artery bypass surgery with cardiopulmonary bypass. The patients were randomly divided into two groups. In group 1 (dialysis group, 21 patients), perioperative prophylactic hemodialysis was performed in all patients. Group 2 (23 patients) was taken as a control group and hemodialysis was performed only if postoperative acute renal failure was diagnosed. RESULTS: The hospital mortality was 4.8% (1 patient) in the dialysis group, and 30.4% (7 patients) in the control group (p = 0.048). Postoperative acute renal failure requiring hemodialysis was seen in 1 patient (4.8%) in the dialysis group and in 8 patients (34.8%) in the control group (p = 0.023). Thirty-three postoperative complications were observed in the control group for an early morbidity of 52.2% (12 patients) and 13 complications occurred in 8 patients in the dialysis group (38.1%). The average length of the intensive care unit and postoperative hospital stay were shorter in the dialysis group than in the control group (p = 0.005 and p = 0.023, respectively). CONCLUSIONS: Preoperative creatinine levels higher than 2.5 mg/dL, increase the risk of mortality and the development of acute renal failure and prolong the length of hospital stay after on-pump coronary artery bypass surgery. Perioperative prophylactic hemodialysis decreases both operative mortality and morbidity in these high-risk patients.     

术中静脉输注乌司他丁对非体外循环冠状动脉旁路移植术患者围术期肺功能的影响

目的 评价术中静脉输注乌司他丁对非体外循环冠状动脉旁路移植术(OPCABG)患者围术期肺功能的影响.方法 择期OPCABG患者24例,NYHA心功能分级Ⅰ或Ⅱ级,年龄65～75岁,随机分为对照组(C组,n=12)和乌司他丁组(U组,n=12).U组于气管插管后经30 min静脉输注乌司他丁6 000 U/kg,随后以1 000 U·kg-1·h-1的速率静脉输注至术毕,C组采用同样方法静脉输注等容量生理盐水.分别于术前(T1)、术毕即刻(T2)、术后4 h(T3)、8 h(T4)和20 h(T5)时测定血浆白细胞介素6(IL-6)浓度、中性粒细胞CD11b/CD18表达水平、血清一氧化氮(NO)浓度,并行血气分析,计算肺泡-动脉血氧分压差[P(A-a)O2]和呼吸指数(RI);记录重症监护室期间机械通气时间.结果 与T1时比较,C组T3.4时血浆IL-6浓度、T2～5时中性粒细胞CD11b/CD18表达水平、P(A-a)O2和RI升高,血清NO浓度降低,U组T2～5时P(A-a)O2和RI升高(P<0.05或0.01),其余指标差异无统计学意义(P<0.05);与C组比较,U组T3.4时血浆IL-6浓度、T2～5时中性粒细胞CD11b/CD18表达水平、T2.3时RI和P(A-a)O2降低,T2.3时血清NO浓度升高(P<0.05或0.01);C组重症监护室期间机械通气时间长于U组(P<0.05).结论 术中静脉输注乌司他丁可改善OPCABG患者围术期肺功能,其机制可能与降低全身炎性反应有关.