初探非体外循环冠脉搭桥术后全身炎症反应

目的 以血清高敏C-反应蛋白为炎症标志物，对比传统体外循环冠脉搭桥术评价非体外循环冠脉搭桥术后全身炎症反应。方法入选36例冠状动脉粥样硬化性心脏病患者，分体外循环冠脉旁路移植组15例，非体外循环冠脉旁路移植组21例，采用胶乳比浊法测定人选者围术期血清高敏C反应蛋白水平，评价两组术式的对全身的炎症反应情况。结果两组患者血清高敏C-反应蛋白水平术前无明显差异（P〉0．05），非体外循环冠状动脉旁路移植组术中肝素化后1h与术前比较无明显差异（P〉0．05），12h后开始升高（P〈0．05），24h达到峰值（P〈0．01）。体外循环冠状动脉旁路移植组体外循环后1h后与术前比较即开始升高（P〈0．05），体外循环12h后明显升高（P〈0．05），24h达到峰值（P〈0．01）。两组血清高敏C-反应蛋白水平的总体变化趋势相似，但OPCAB组相对处于低水平（P〈0．05）。结论非体外循环冠状动脉旁路移植术后血清高敏C-反应蛋白水平明显低于体外循环冠状动脉旁路移植术；非体外循环冠状动脉旁路移植术能有效减轻缺血再灌注损伤和全身炎症反应。

Preliminary observation after off-pump coronary artery bypass systemic inflammatory response

Objective The serum high-sensitivity C-reactive protein as a marker of inflammation,compared to the traditional off-pump coronary artery bypass evaluation of the off-pump coronary artery bypass grafting after systemic inflammatory response.Methods The selected 36 cages of coronary heart disease,the subgroup of off-pump coronary artery bypass grafting in 15 cases,off-pump coronary artery bypass grafting group of 21 patients,using latex assay were selected perioperative serum Hish-sensitivity C-reactive protein level,the two groups evaluate the operation of the whole body of the inflammatory response.Results The two groups of patients with serum high-sensitivity C-reactive protein level of pre-operative there was no significant difference(P＞0.05),off-pump coronary artery bypass graft surgery in the heparin group after 1 hours compared with the preoperative there was no significant difference(P＞0.05),12 hours after the increase(P＜0.05),24 hours peak(P＜0.01).Off-pump coronary artery bypass grafting off-pump group after 1 h and after the operation began earlier increased (P＜0.05),significantly increased after 12 h cardiopulmonary bypass(P＜0.05),24 h peak(P＜0.01).Serum high-sensitivity C-reactive protein level of the overall trend was similar,but the relatively low level of OPCAB group(P＜0.05).Conclusion Off-pump coronary artery bypass graft serum high-sensitivity C-reactive protein levels were significantly lower than off-pump coronary artery bypass grafting;off-pump coronary artery bypass grafting can effectively reduce the ischemia-reperfasion injury and the whole body Inflammatory response.