常温体外循环心脏缓慢空跳状态下心肌保护效果的实验研究

目的　评价常温体外循环心脏缓慢空跳术式对心肌保护效果的影响。方法　杂种犬 12只 ,随机分为停跳组和空跳组。两组均常规建立体外循环。停跳组阻断升主动脉 ,心脏灌注冷晶体停跳液 ;空跳组不阻断升主动脉 ,以一定的灌注压力和流量维持心脏空跳。分别于停跳 (开机 )前、停跳 (空跳 ) 90min、复跳 (撤机 ) 30min ,抽冠状窦血行有关生化检测、取右心室心肌行病理组织检查。结果　停跳组在刚复跳及复跳 30min其冠状窦血中丙二醛 (malondialdehyde ,MDA)及乳酸脱氢酶同工酶 (lacticaiddehydrogenase,LDH1)值均显著高于停跳前 (P <0 0 5 ) ,并显著高于空跳组撤机 30min时的MDA及LDH1值 (P <0 0 5 ) ;而空跳组在研究时段12 0min内其心脏冠状窦血MDA及LDH1值均无显著性差异(P >0 0 5 )。在心肌超微结构改变方面 :停跳组在停跳 90min及复跳 30min ,均出现较严重心肌损伤的改变 ,而空跳组同样时段仅出现轻度可逆性改变。结论　体外循环下空跳法在减少心肌损害 ,避免缺血再灌注损伤方面优于停跳法。     

老年患者非体外循环冠脉搭桥术围术期心肌损伤相关指标和心脏功能

目的探讨非体外循环冠脉搭桥术(CABG)应用于老年患者围术期心肌损伤相关指标和心脏功能的变化情况。方法以2011年6月至2012年6月采用非体外循环CABG治疗的30例老年冠心病患者(观察组)为研究对象,观察围术期心肌损伤生化标志物和临床指标,以及心脏功能的变化;同时,回顾性分析同期进行体外循环CABG治疗的30例老年冠心病患者(对照组)的临床资料,对两组的数据进行对比分析。结果 (1)两组患者围术期血肌钙蛋白Ⅰ(cTnⅠ)、肌酸激酶同工酶(CK-MB)的变化趋势基本一致,术后有轻度升高,术后24 h达到最高峰,术后168 h恢复到手术前水平。与体外循环组相比,非体外循环组cTnI及CK-MB含量均明显降低(P<0.01)。(2)术后即刻、术后2、12 h观察组患者的心脏指数(CI)、左室收缩压(LVSP)、左室做功指数(LVSWI)以及右室做功指数(RVSWI)水平均高于对照组(P<0.05)。(3)观察组采用主动脉内球囊反搏(IABP)者与未采用IABP者术后CI及严重并发症的发生情况差异无统计学意义(均P>0.05);观察组患者IABP放置后,CI逐步下降,平均动脉压上升,尿量增多,血管活性药物用量逐渐减少。结论非体外循环CABG对患者围术期心肌损伤和心脏功能不良影响小,与体外循环手术相比,结合IABP更可提高其手术的安全性,值得临床推广应用。     

含血持续灌注加开放前温血灌注在危重瓣膜病人中的应用

目的:探讨应用含血心肌保护液持续灌注加主动脉开放前温血加甘露醇持续灌注在危重瓣膜病人手术中心肌保护的效果。方法:对159例连续危重瓣膜置换术的病人进行分析,实验组(组Ⅰ)83例,采用中度低温含血心肌保护液持续灌注加主动脉开放前温血+甘露醇持续灌注;对照组(组Ⅱ)76例,采用单纯中度低温含血心肌保护液持续灌注。观察心脏自动复跳率,心脏停跳、主动脉阻断、辅助时间,应用持续左心功能监测仪(CCO)观察左心功能的变化,计算氧摄取率,测定血浆丙二醛(MDA)及心肌酶CK的变化。结果:两组心脏停跳良好,血流动力学指标无明显差异。心脏自动复跳率组Ⅰ为100.0％,组Ⅱ为68.4％(P<0.01);主动脉阻断、辅助时间及心肌氧摄取率无明显差异;心脏停跳时间组工较组Ⅱ缩短(11.4±3.2)min;CCO显示术后左心功能组Ⅰ较组Ⅱ恢复快;MDA的变化组Ⅰ较组Ⅱ产量低(P<0.05)。结论:采用含血心肌保护液持续灌注加主动脉开放前温血加甘露醇持续灌注的心肌保护方法,能够明显减轻术后早期再灌注损伤,加快术后左心功能恢复。     

心脏瓣膜置换术中心脏复跳前主动脉根部 灌注腺苷对心肌的保护作用

摘要: 目的 研究在心脏瓣膜置换术中心脏复跳前主动脉根部灌注腺苷对心肌的保护作用。 方法 42例行心脏瓣膜置换术患者随机分为两组,腺苷组在心脏瓣膜置换完成后,心脏复跳前主动脉根部灌注入外源性腺苷,对照组心脏复跳前不灌注外源性腺苷,按照常规处理。术前、主动脉开放后4h、12h、24h采集患者桡动脉血,测心肌型肌酸激酶同工酶(CK-MB)、肌钙蛋白I(cTn-I)。观察心脏停跳情况,术后机械通气时间及术后正性肌力药物的应用情况,心肌超微结构的改变。 结果 腺苷组的肌酸激酶同工酶水平在主动脉开放后4h、12h,肌钙蛋白I水平在主动脉开放后4h、12h、24h较对照组低。透射电镜见腺苷组心肌损伤较对照组明显减轻。 结论　在心瓣膜置换术中心脏复跳前主动脉根部灌注腺苷能显著提高心肌保护效果。     

70岁以上老年人冠状动脉旁路移植术的心肌保护

目的　对比观察非体外循环冠状动脉旁路移植术 (OPCAB)与体外循环下微温血和冷血停搏液灌注冠状动脉旁路移植术 (CABG)对老年患者的心肌保护效果。　方法　将 4 5例 70岁以上行CABG患者随机分为 3组 ,OPCAB组、间断微温血和冷血含氧心脏停搏液灌注组各 1 5例。 3组患者术前心功能、性别、年龄、冠状动脉病变情况差异无显著性 ;各组于围术期不同时点分别抽取静脉血测定肌酸激酶同工酶 (CK MB)、肌钙蛋白I(cTnI)及观察围术期监护情况。　结果　OPCAB组术中、术后各时点CK MB、cTnI与微温血和冷血CABG组比较差异有显著性 (P <0 0 5 ) ;CK MB在冷血CABG组术后 1d达到峰值 (5 7 75± 34 2 4 )U/L ,此时点OPCAB组和微温血CABG组CK MB值分别为 (2 2 6 4± 1 2 0 5 )和 (42 85± 2 9 0 4 )U/L ,cTnI在OPCAB组术后 6h达到峰值 (0 6 9± 0 2 0 )μg/L ,而微温CABG组与冷血CABG组比较差异有显著性 (P <0 0 5 ) ,OPCAB组围术期监护情况明显优于微温和冷血停搏CABG组 (P <0 0 5 )。　结论　对老年冠心病患者心肌保护中 ,OPCAB组心肌保护效果优于CABG组 ,微温血CABG组优于冷血CABG组。与CK MB相比 ,cTnI是评价心肌损害较敏感和特异的指标     

阿司匹林对心肌肥厚大鼠心功能和炎症因子的影响

目的探讨阿司匹林对压力超负荷性心肌肥厚大鼠血浆和心肌组织肿瘤坏死因子-α(TNF-α)、白介素-10(IL-10)、血栓素A2(TXA2)和前列环素I2(PGI2)的影响。方法将30只实验大鼠分为手术组、非手术组和药物组。采用腹主动脉狭窄法制备心肌肥厚大鼠模型,通过测定4周及8周尾动脉血压实验及左心室质量指数评定造模情况。采用超声心动图评价心脏功能,酶联免疫吸附实验(ELISA)法检测心肌组织及血浆TNF-α、IL-10、TXA2、PGI2水平。结果术后4周,手术组及药物组较术前动脉血压升高(P<0.05),且术后8周升高更显著(P<0.01)。术后8周,手术组左心室重量指数(LVMI)较假手术组显著增高(P<0.05)。术后4周,手术组心肌组织及血浆TNF-α、TXA2较假手术组显著升高(P<0.01),术后8周升高更显著(P<0.01);药物组TNF-α、TXA2较手术组明显下降(P<0.01)。术后4周,手术组PGI2较假手术组下降,术后8周下降更显著(P<0.01)。结论阿司匹林能改善心功能,减少心肌细胞短轴直径,改善左室肥厚。     

含血持续灌注加开放前温血灌注在危重瓣膜病人中的应用

目的探讨应用含血心肌保护液持续灌注加主动脉开放前温血加甘露醇持续灌注在危重瓣膜病人手术中心肌保护的效果.方法对159例连续危重瓣膜置换术的病人进行分析,实验组(组Ⅰ)83例,采用中度低温含血心肌保护液持续灌注加主动脉开放前温血+甘露醇持续灌注;对照组(组Ⅱ)76例,采用单纯中度低温含血心肌保护液持续灌注.观察心脏自动复跳率,心脏停跳、主动脉阻断、辅助时间,应用持续左心功能监测仪(CCO)观察左心功能的变化,计算氧摄取率,测定血浆丙二醛(MDA)及心肌酶CK的变化.结果两组心脏停跳良好,血流动力学指标无明显差异.心脏自动复跳率组Ⅰ为100.0%,组Ⅱ为68.4%(P＜0.01);主动脉阻断、辅助时间及心肌氧摄取率无明显差异;心脏停跳时间组Ⅰ较组Ⅱ缩短(11.4±3.2)min;CCO显示术后左心功能组Ⅰ较组Ⅱ恢复快;MDA的变化组Ⅰ较组Ⅱ产量低(P＜0.05).结论采用含血心肌保护液持续灌注加主动脉开放前温血加甘露醇持续灌注的心肌保护方法,能够明显减轻术后早期再灌注损伤,加快术后左心功能恢复.     

温血间断灌注在心脏瓣膜置换术中的心肌保护作用的探讨

目的 探讨温血停跳液间断灌注心肌保护方法在心脏瓣膜置换手术中的应用效果.方法 在154例心脏瓣膜置换术中,采用温血停跳液间断灌注(A组)80例,冷晶体停跳液间断灌注(B组)74例,观察比较两组的体外循环(CPB)时间、主动脉阻断时间、主动脉开放后心脏自动复跳率、呼吸机辅助时间、术后低心排发生率、ICU时间、术后住院天数、正性肌力药物使用情况及术中后各时间点的心肌酶学指标.结果 两组CPB时间、主动脉阻断时间、ICU时间差异无统计学意义(P>0.05).而A组主动脉开放后心脏自动复跳率较高,呼吸机辅助时间、术后低心排发生率、术后住院天数、正性肌力药物使用量及时间明显低于B组,差异有统计学意义(P<0.05).术后4 h和24 h,温血停跳液间断灌注组心肌酶指标较低(P<0.05).两组患者均痊愈出院,随访3个月至5年,心功能恢复良好.结论 温血停跳液间断灌注比冷晶体停跳液间断灌注具有更好的心肌保护效果.     

温血停跳液持续灌注与冷晶体停跳液间断灌注对心肌保护作用的比较

本文从临床效果、心肌酶代谢及细胞超微结构的变化方面，比较温血停跳液持续灌注与冷晶体停跳液间断灌注对心肌的保护作用。结果为，常温组术后自动复跳率为９２．３％，低温组仅２３．１％；常温组心肌酶释放减少，术后心脏功能恢复较快；心肌超微结构观察显示常温组细胞线粒体损伤较轻，心肌破坏较少。表明常温体外循环行温血停跳液持续灌注，对心肌的保护作用较以往的低温体外循环用冷晶体停跳液间断灌注为佳。     

心肌肌钙蛋白Ⅰ对体外循环心内直视手术心肌损伤的判定价值

目的探讨心肌肌钙蛋白Ⅰ(cTn Ⅰ)对体外循环心内直视手术心肌损伤的判定价值.方法40例心脏瓣膜置换手术病人随机分为两组,冷晶体停跳液组(A组),温血停跳液组(B组),每组20例,分别于圈手术期多时点采取中心静脉血,测定血清cTn Ⅰ、心肌肌酸激酶(CK)及其心肌肌酸激酶同工酶(CK-MB).结果术前两组的cTn Ⅰ、CK及CK-MB水平均在正常范围,开放主动脉后1 h至术后24 h达峰值,其后缓慢下降.术后24 h、48 h B组cTnⅠ水平明显低于A组(P＜0.05),CK-MB在开放主动脉后1 h B组低于A组.cTn Ⅰ峰值浓度与主动脉阻断时间呈直线正相关.结论cTn Ⅰ判定心内直视手术围手术期心肌损伤的敏感性及特异性明显优于OK、CK-MB,对围手术期心肌缺血损伤的诊断、预后及心肌保护效果的评价具有重要的临床价值.     

埃索美拉唑对体外循环心脏手术应激性溃疡保护作用的临床观察

目的:探讨埃索美拉唑对体外循环(CPB)心脏手术应激性溃疡的保护作用。方法:208例在体外循环下行瓣膜成形术和/或瓣膜置换术的心脏瓣膜病及需行冠状动脉搭桥(CABG)术的冠心病患者及需行心脏矫治术的先天性心脏病(先心病)患者,随机分为2组,对照组96例给予常规治疗,埃索美拉唑组112例,术前给予口服埃索美拉唑片40 mg/d,1 w;术中静注埃索美拉唑注射液40 mg,1次/d;术后静注埃索美拉唑注射液40 mg/d,3 d;分别于术前测大便OB试验1次,术后4h、术后第1天、术后第2天测胃黏膜pH值(pHi)。结果:埃索美拉唑组手术后4 h、术后第1天术后第2天测胃黏膜pH值(pHi)分别为6.01±0.64,6.32±0.59及6.58±0.39,而对照组手术后4 h、术后第1天、术后第2天测胃黏膜pH值(pHi)分别为3.21±0.22,3.67±0.34及3.43±0.41,与对照组比较,埃索美拉唑组pHi值明显高于对照组(P<0.01)。结论:埃索美拉唑可预防CPB心脏手术应激性溃疡。     

Myocardium utilizes more oxygen and glucose during tepid blood cardioplegic infusion in arrested heart

The aims of this study were to evaluate myocardial metabolic activity during tepid blood cardioplegic infusion in the arrested heart in comparison with cold blood cardioplegia and to assess the early clinical outcomes of these patients. Thirty patients undergoing first elective coronary artery bypass grafting surgery were included and randomized to two groups (T for tepid and C for cold), 15 patients in each. Myocardial protection was similar in both groups except for the reinfusion of blood cardioplegia, which was 6 degrees C in group C and 28 degrees C in group T (same temperature as the body perfusion). The route of cardioplegic reinfusion was antegrade during the first reinfusion and retrograde during the second reinfusion. In order to assess myocardial metabolic activity, myocardial oxygen consumption (MVO2), myocardial glucose uptake, and myocardial lactate and acid production were all calculated. Arterial and coronary venous blood samples were obtained from the aortic root cannula and coronary sinus. During cardioplegic re-infusions in the ischemic period, the calculated values of myocardial oxygen extraction, oxygen consumption, and glucose uptake were higher in group T than in group C (P < 0.05). This difference was observed during both antegrade and retrograde delivery of cardioplegic solution. Myocardial lactate production was greater in group C than in group T during cardioplegic reinfusion, both antegradely and retrogradely (P < 0.05). In all patients, cardiopulmonary bypass was terminated in the first attempt. The clinical outcome was similar in both groups. The results of this study indicate that globally ischemic myocardium is able to utilize more oxygen and glucose during cardioplegic re-infusions at a tepid temperature in comparison to cold. In addition, the data showed evidence of less myocardial injury and better left ventricular function throughout the critical period of recovery from global ischemia for the heart protected by tepid cardioplegia.     

Does off-pump coronary revascularization reduce the release of the cerebral markers, S-100beta and NSE?

OBJECTIVES: The aims of this study were to (1) compare the release of S-100 beta and NSE in off-pump coronary artery bypass grafting (CABG) versus on-pump surgery; (2) investigate whether the S-100 beta and NSE serum concentrations correlate with cardiopulmonary bypass (CPB) duration. MATERIALS AND METHODS: Between October 2002 and May 2004, 42 patients undergoing first time CABG surgery were enrolled in the study. The exclusion criteria were: LVEF<35%, age>70 years, previous myocardial infarction, REDO surgery, the presence of valvular heart disease and/or cerebrovascular disease, abnormal preoperative carotid vessels angiography, coronary artery disease involving the distal circumflex artery, renal dysfunction, coagulopathy. The patients were randomly assigned either to undergo on-pump CABG surgery [group I, n=24 patients] or off-pump CABG [group II, n=18 patients]. Blood was not re-transfused from the cardiotomy suction. All patients presenting haemolysis were excluded from the study. RESULTS: The preoperative S-100beta was 0.13+/-0.08 (microg/l) and NSE 7+/-1.5 (microg/l) in group I and 0.12+/-0.1 (microg/l) and 6.9+/-2.7 (microg/l), respectively in group II. Six hours after the surgery, S-100beta in patients of group I reached a maximum level of 1.38+/-0.4 (microg/l) and NSE of 17.7+/-6.5 (microg/l) compared to 0.5+/-0.11 (microg/l) [S-100B] and NSE 8.6+/-4.2 (microg/l) in group II (p=0.001). Three (12%) patients in group I and none (0%) in group II suffered postoperative delirium, p=0.247. No strokes occurred linear regression analysis revealed a strong correlation between cardiopulmonary bypass duration and S-100beta and NSE peak levels, p<0.0021 (r(2)=0.36) and p<0.0001 (r=0.81), respectively. CONCLUSION: Coronary artery bypass surgery with CPB causes a significantly greater increase in NSE and S-100beta serum levels than off-pump surgery and correlates with CPB duration.     

Beneficial effect of the addition of nitroglycerin to the cardioplegic solution on lipid peroxidation during coronary artery bypass surgery

The effects of the addition of a nitric oxide (NO) donor to the cardioplegic solution on reperfusion injury and lipid peroxidation (LPO) in coronary artery bypass grafting (CABG) are not known. Therefore, this work was conducted to determine the possible effects of nitroglycerin on LPO and reperfusion injury as a result of CABG. A prospective double-blind, placebo-controlled study was conducted in 30 consecutive patients with coronary artery disease who underwent CABG with cardiopulmonary bypass. The patients were randomly assigned to receive 3 microg/kg of nitroglycerin added to the cardioplegic solution (NTG group) or 3 microg/kg of placebo added to the cardioplegic solution (placebo group). MDA increased significantly in the placebo group compared to the NTG group during the ischemic (P < 0.01) and reperfusion periods (P < 0.01). The level of troponin I decreased significantly in the NTG group compared to the placebo group during the ischemic and reperfusion periods (P < 0.001). The level of NO increased significantly in the NTG group compared to the placebo group during the ischemic and reperfusion periods (P < 0.01). LPO was increased in response to CPB during CABG, together with simultaneous decreases in serum nitric oxide levels, whereas LPO was significantly decreased in response to CPB with nitroglycerin, together with simultaneous increases in the levels of serum nitric oxide.     

Clinical experience of coenzyme Q10 to enhance intraoperative myocardial protection in coronary artery revascularization

Seventy-eight patients undergoing coronary artery bypass grafting (CABG) were compared retrospectively to evaluate whether pretreatment with coenzyme Q₁₀ (CoQ) is effective in preventing left ventricular depression in early reperfusion following CABG. CoQ (5 mg/kg, intravenously) was given to 60 patients, 2 hours prior to the onset of cardiopulmonary bypass (CPB). CABG was performed using saphenous vein under CPB associated with cold cardioplegia in the standard fashion. Heart rate, mean arterial pressure, and cardiac index showed no significant difference between the CoQ and control groups. However, left ventricular stroke work index was significantly elevated at 6 and 10 hours of reperfusion following CABG in the CoQ-treated group compared with the controls. Serum MB-CK was lower at 0 and 6 hours of reperfusion in the CoQ group compared with the controls. These results suggest that pretreatment with intravenous CoQ is effective in preventing left ventricular depression in early reperfusion and in minimizing myocardial cellular injury during CABG followed by reperfusion.     

经皮冠状动脉腔内介入与冠状动脉搭桥手术治疗冠心病

目的:观察冠心病(CHD)完全再血管化(CR)与非完全再血管化(ICR)的远期随访结果。方法:回顾性分析作者在美国犹他大学LDS医院研修时参与的4948例CHD患者接受冠状动脉搭桥术(CABG)和经皮冠状动脉腔内介入治疗(PCI)CR与ICR的远期随访结果。结果:多支冠状动脉病变PCI-ICR与PCI-CR相比,PCI-ICR组患者发生心肌梗死(MI)、再行CABG、重复PCI、再发心绞痛以及死亡的比率均稍高于PCI-CR组,但差异均无显著性意义。单支多处病变PCI-ICR与PCI-CR相比,1年再发心绞痛及再行CAGB较高(P<0.01),但MI及死亡率差异无显著性意义(P>0.05)。结论:CHD患者PCI-ICR的策略是可行的。     

Peri-operative myocardial tissue injury and the release of inflammatory mediators in coronary artery bypass graft patients

OBJECTIVE: This study was conducted to evaluate to what extent the ischemia-reperfusion injury resulting from the cardiopulmonary bypass (CPB) and aortic cross-clamping procedures during coronary artery bypass grafting (CABG) contributes to the systemic inflammatory response generally found in these patients. METHODS: Serum levels of enzymes (CK and CK-MB) and non-enzymatic proteins (FABP and myoglobin) as markers of myocardial tissue injury, bactericidal permeability increasing protein (BPI) as an indicator of neutrophil activation, interleukin-6 (IL-6) as inducer of the acute phase response and lipopolysaccharide binding protein (LBP) as parameter of the acute phase response were measured in 15 low-risk CABG patients with cardiopulmonary bypass (CPB), and 17 low-risk CABG patients without CPB. RESULTS: Already 0.5 h after reperfusion significantly increased plasma levels of all markers of myocardial tissue injury were noted in patients having surgery with CPB, but not in non-CPB patients. No significant differences were found between both groups for BPI and IL-6 levels in the early reperfusion period. BPI and IL-6 levels were higher in the non-CPB group on the first post-operative day (P < 0.05). However, no correlations were found for any marker of peri-operative tissue damage with either early neutrophil activation, or acute phase reactants. CONCLUSIONS: Perioperative myocardial injury resulting from CPB and aortic cross-clamping in low-risk CABG patients does not contribute to the release of inflammatory mediators in these patients.     

Correlation of the myocardial performance index with conventional echocardiographic indices of systolic and diastolic function: a study in cardiac surgical patients

BACKGROUND: The aim of this investigation was to compare the myocardial performance index (MPI), a Doppler-derived parameter of global ventricular function, with standard echocardiographic measures of systolic and diastolic function in patients undergoing coronary artery bypass graft (CABG) surgery. METHODS: Complete two-dimensional and Doppler examinations were performed on 46 CABG patients after induction of anesthesia (baseline), 15 minutes postcardiopulmonary bypass (CPB), and at the end of the surgical procedure. RESULTS: A strong inverse correlation between MPI and both fractional area change (adjusted r(2)= 0.588-0.802) and ejection fraction (adjusted r(2)= 0.576-0.656, both P < 0.001) of the left ventricle was observed throughout the intraoperative period. Following CPB, a weaker correlation was observed between MPI and overall diastolic heart function classification (adjusted r(2)= 0.224-0.268, P <0.001). Weak, though statistically significant, correlations were observed between MPI and deceleration time (P < 0.05), peak atrial reversal (AR) wave velocity (P < or =0.002), and duration of the AR wave (P < 0.05). CONCLUSION: Our data suggest that the MPI correlates well with standard echocardiographic measures of systolic function and modestly well with overall diastolic heart function classification. The MPI may be a useful, complementary marker of global left ventricular function in patients undergoing CABG surgery.     

复合辅酶对冠心病患者围术期心肌保护和肝脏保护作用的研究

目的:探讨冠心病(CAD)患者体外循环(CPB)冠状动脉旁路移植(CABG)术中使用复合辅酶对心肌和肝脏保护的效果。方法:70例择期CPB下进行CABG的CAD患者,随机分为试验组与对照组各35例,试验组术中给予辅酶A1000u和辅酶I1.0mg,对照组不给复合辅酶。观察CPB时间、主动脉阻断时间、正性肌力药使用情况、ICU停留时间、术后住院时间、围术期心肌梗死和脑卒中等临床指标。2组分别于手术开始前、手术结束时、手术后6h、12h、24h和术后3d采集患者中心静脉血,检测红细胞压积、肌酸激酶、肌酸激酶同工酶和肌钙蛋白I;于手术开始前、手术结束时、手术后3d和手术后7d采血检测谷丙转氨酶、谷草转氨酶、总胆红素和直接胆红素。结果:2组术后心肌酶谱均较术前升高(P0.01),但在术后6h、12h和24h试验组心肌酶谱显著低于对照组(P0.01)。2组术后转氨酶和胆红素水平均较术前升高(P0.01),但在术后3d试验组的转氨酶和胆红素水平显著低于对照组(P0.01)。结论:CAD患者围术期应用复合辅酶具有一定的心肌保护和肝脏保护作用。     

Operative Factors that Contribute to Post-Operative Atrial Fibrillation: Insights from a Prospective Randomized Trial

Atrial fibrillation (AF) is the most common complication following cardiac surgery and is associated with significant increases in postoperative morbidity, length of stay and cost of care. In a randomized study we assessed the impact of coronary artery bypass grafting (CABG) without cardiopulmonary bypass (CPB) (off-pump, n = 100), compared to conventional (on-pump, n = 100) CABG, on the frequency of postoperative AF. Arrhythmias were detected using an automated arrhythmia detector for the first 72 hours following surgery and by four hourly clinical observations thereafter. AF was defined as an irregular narrow complex rhythm (in the absence of bundle branch block) with absence of discrete P waves lasting greater then 10 minutes. There was a significant reduction in the incidence of postoperative AF in the off-pump group (11% versus 45%, P < 0.001) in addition to significant reductions in blood usage, postoperative pneumonia, inotrope requirements, and hospital and intensive care unit stay. Univariate analysis identified all these variables as risk factors for AF, however multivariate regression analysis identified CPB and cardioplegic arrest as the only independent predictor of postoperative AF (OR 7.4; 95% CI 3.4 to 17.9). This study therefore suggests that the inflammatory response to bypass, myocardial ischaemia and atrial cannulation are significant contributory factors to the development of AF following cardiac surgery. In the light of more recent trials it is apparent that this benefit may be most marked in patients with multiple perioperative risk factors for postoperative AF.