冠心病围术期肾素-血管紧张素-醛固酮系统变化的研究

目的：研究冠心病围术期肾素一血管紧张素．醛固酮系统（RAAS）及血流动力学规律，为临床冠心病围术期的治疗提供参考。方法：37例冠心病患者分为4组，组1行体外循环下的冠状动脉旁路移植术（CABG）＋室壁瘤切除，组2行CABG，组3行非体外循环下的冠状动脉旁路移植术（OPCABG），组4行激光心肌打孔（TMLR）；10例瓣膜病患者（组5）作为对照组。采用放射免疫法测定并就比较各组血管紧张素Ⅱ（AGII）和醛固酮（ALD）水平。结果：AGII：组内：组1、2主动脉开放时及术后3、6、24h明显高于术前（P〈0．05），组3、4术后无明显升高（P〉0．05），组5阻断前、主动脉开放时、术后3h明显高于术前（P〈0．05）；组间：组2术后3h明显高于组3、4（P〈0．05）。ALD：组内：组1、2及5主动脉开放时、术后3h显著高于术前（P〈0．05）；组间：组2开放时、术后3h显著高于组3、4（P〈0．05），组5高于其它各组各时间点（P〈0．05）。结论：冠心病围术期R气AS活性明显低于瓣膜病组，术后早期RAAS活性升高。CABG患者RAAS升高更为明显，但24h以内恢复正常。非体外循环下搭桥和激光心肌打孔患者，心功能恢复快，全身反应相对较轻。

The study of RAAS and hemodynamics during perioperative coronary artery disease

Objective: Renin-Angiotensin-Aldosterone system(RAAS) and hemodynamics parameters were studied during perioperative coronary artery disease(CAD) with different treatments,such as coronary artery bypass grafting(CABG) with cardiopulmonary bypass(CPB) or without CPB or transmyocardial laser revascularization(TMLR),in order to detect some difference in CABG among these treatments.Methods: Forty-seven patients were studied.They were divided into 5 groups.Group 1:CABG+Aneurysm.Group 2: classical CABG,CABG with CPB.Group 3: OPCABG,CABG without CPB.Group 4: TMLR.Group 5,the control group,patients,with rheumatic heart disese(RHD),underwent mitral valve replacement.Angiotensin(AGII) and Aldosterone(ALD) were measured by radioimmunoassay in the following time: before operation,before revascularization(before aortic clamping),just after revascularization(Aortic declamping),3,6,24 hours after revascularization.Results: AGII: in group 1,2,it increased significantly after operation.In group 3 and group 4,there is no difference before and after operation.In group 5,it increased significantly before CPB,in the end of valve replacement,and in 3,6,24 hours after operation.The AGII level was higher in group 2 than in group 3 in 3 hours after operation.ALD: in group 1,2,5 it increased significantly when declamping the aorta,and in 3 hours after operation.ALD level was higher in group 2 than in group 3 in the end of CABG and 3 hours after operation.Also,the ALD level was higher in group 5 than in any group of CAD in each point.Conclusion: RAAS activity in CAD groups is lower than in RHD group.The changes of the neurohormonal factors in CABG with CPB are much more than those without CPB and in TMLR.But the changes resulted by CPB are temporary and acceptable.To the patients undergoing CABG without CPB,the heart function recovers quickly.Thus it's better that the patients undergo CABG without CPB if the indications are suitable.TMLR is a good and useful supplement for CAD therapy.