冠状动脉搭桥患者围术期血浆15-F2t-isoprostane含量变化及临床意义

目的　分析常温心脏手术中血浆游离 15 F2 t isoprostane浓度变化及其与术后早期心功能的关系。方法　选择 30例在常温体外循环 (CPB)下行冠状动脉搭桥术患者 ,根据术后有 (组 )、无 (组 )应用正性肌力药物分为两组。 CPB中采用间断温血灌注 ,分别于麻醉诱导后、阻升主动脉后 30 min以及开放升主动脉后 10、30和 12 0 min抽取中心静脉血样 ,采用有高度特异性的兔血清抗体用酶标放射免疫法测量血浆中游离 15 F2 t isoprostane含量。术中至术后 6 h进行连续心排量测量。结果　 15 F2 t isoprostane血浆含量于阻升主动脉后 30 m in、开放升主动脉后 10 min显著升高 ,开放升主动脉 30 m in以后开始下降。组 患者血浆 15F2 t isoprostane含量的升高呈递减趋势 ,至开放升主动脉后 30 min恢复正常 ;相反 ,术后需两种以上正性肌力药物支持以维持心脏指数 (CI) >2 .2 L· m in- 1· m- 2的患者 (组 )血浆 15 F2 t isoprostane含量至开放升主动脉后 30 m in均显著高于正常。术后 CI与开放升主动脉后 10和 30 min时血浆游离 15 F2 t isoprostane含量呈良好的负相关性 (r=- 0 .95 ,P<0 .0 1)。结论　术中 15 F2 t isoprostane血浆含量与术后心功能的恢复密切相关。

Clinical significance of plasma free 15-F2t-isoprostane concentration during coronary artery bypass graft surgery

OBJECTIVE: To analyse retrospectively the variation of plasma 15-F2t-isoprostane concentration during cardiac surgery and the relation with early myocardial dysfunction following normothemic cardiac surgery. METHODS: Thirty patients scheduled for coronary artery bypass graft surgery using normothermic cardiopulmonary bypass (CPB) and warm intermittent blood, crystalloid cardioplegia were enrolled. Patients were divided into two groups treated with (group II) or without (group I) positive inotropic drugs. Central venous blood was sampled at baseline, 30 minutes after global myocardial ischemia, 10, 30 and 120 minutes after aortic declamping (reperfusion). Plasma free 15-F2t-isoprostane was measured with enzyme immunoassay (EIA) using a highly specific rabbit 15-F2t-isoprostane antibody. Cardiac index (CI) was monitored intraoperatively and up to 6 hours following surgery. RESULTS: Plasma free 15-F2t-isoprostane increased significantly during ischemia, remained elevating at 10 minutes after reperfusion (P<0.05 vs. baseline) and began to decline at 30 minutes after reperfusion in the whole population. 15-F2t-isoprostane underwent exponential decay and returned to baseline at 30 minutes after reperfusion in group I that did not need any postoperative inotropic support. In contrast, 15-F2t-isoprostane further increased upon reperfusion and remained significantly higher than baseline at 30 minutes after reperfusion (P<0.05) in group II that needed two or more inotropes to maintain CI greater than 2.2 L x min(-1) x m(-2). Postoperative CI was significantly inversely correlated with the percentage change in plasma free 15-F2t-isoprostane concentration from 10 to 30 minutes after reperfusion (r=-0.95, P<0.01). CONCLUSION: It shows a close relationship between free plasma concentrations of 15-F2t-isoprostane and early postoperative cardiac function following coronary artery bypass graft surgery.