常规与非体外循环冠状动脉旁路移植术炎症因子比较

目的：比较多支冠状动脉（冠脉）病变行常规体外循环冠状动脉旁路移植术（CABG）和非体外循环冠状动脉旁路移植术（OPCAB）围术期心肌损伤和炎症因子的变化情况。方法：CABG组（A组，13例），OPCAB组（B组，22例）。分别于麻醉诱导后、手术结束后即刻、术后24h和48h进行血样检测，分别测定TNF－α、IL-1β、IL-8和IL－10水平。另外记录围手术期各项临床指标如引流量、输血量、呼吸机使用时间和发热时间等。结果：两组在年龄、冠脉病变程度、心功能和血管旁路移植数目上相似。术后IL－8水平OPCAB组相对稍高，但两组无显著差异。围术期CABG组IL－1、TNF较OPCAB明显为高（P＜0．05）。但炎症因子IL－10 OPCAB组却较CABG组明显升高（P＜0．05），术后24h达高峰。最后，CABG较OPCAB病人呼吸机使用时间延长且发热时间延长。结论：与CABG组相比，OPCAB组围术期炎症反应和术后并发发症明显降低。

Off-pump versus on pump coronary bypass: evaluation of inflammatory reaction

Objective: To investigate the effect of multiple coronary artery bypass grafting (CABG) with or without cardiopulmonary bypass (CPB) on the perioperative inflammatory response and myocardial tissue injury. Methods: Thirty-five patients with coronary artery disease were assigned to two groups: conventional CABG (Group A) and OPCAB (Group B). Serum samples were collected for measurement of interleukin 1(IL-1), TNF, IL-8 and IL-10 right after anesthesia induction and 1, 24, and 48 hours postoperatively. Overall, incidence of infection and perioperative clinical outcome was also recorded. Results: Two groups were similar in terms of age, extent of coronary disease, left ventricular function, and number of grafts per patient. IL-1, TNF increased significantly after surgery in the patients of group A (P<0.05). Postoperative IL-10 were significantly higher in the group B than that in group A (P<0.05). Finally, the patients of group A had longer time of fever and ventilation support than patients in group B. Conclusion: Off-pump coronary bypass grafting significantly reduces the inflammatory reaction associated with the use of CPB.