冠心病患者围手术期炎症反应的研究

目的　探讨体外循环或非体外循环下冠状动脉搭桥和激光心肌打孔治疗冠心病时围手术期炎症因子变化的特点 ,为冠心病围手术期的临床治疗提供参考。　方法　测定 37例冠心病患者及 10例瓣膜病患者术前 ,搭桥或打孔前 ,主动脉开放时 (搭桥结束时或打孔后 )及术后 3、6、2 4h的血浆肿瘤坏死因子 (TNF α)、白介素 6 (IL 6 )、C反应蛋白 (CRP)的水平。　结果　术后患者血浆TNF α、IL 6、CRP水平均有一定程度升高 ,使用体外循环患者TNF α为 (4 10± 0 71)pg/ml,显著高于不使用者的 (1 34± 0 2 9)pg/ml,差异有显著性意义 (P <0 0 5 ) ;两者IL 6差异无显著性意义 (P >0 0 5 )。冠状动脉搭桥患者术后CRP为 (12 89± 0 2 9) μg/ml,高于瓣膜病患者的 (12 0± 0 31) μg/ml,差异有显著性意义 (P <0 0 5 )。　结论　冠心病患者 ,冠状动脉搭桥、激光打孔手术后 ,围手术期均有一定程度的炎症反应 ,体外循环者反应较重

Changes of inflammatory factors in patients with coronary artery disease during perioperation

OBJECTIVE: To investigate the proinflammatory cytocine factors in patients with coronary artery disease by different treatments during perioperation. METHODS: TNF-alpha, IL-6, c-reactive protein (CRP) were measured in 37 patients with coronary artery disease (CAD) and 10 patients with mitral valve replacement (MVR, control group) before operation and aortic clamping or before coronary artery bypass grafting (CABG) in the patients with cardiopulmonary bypass, or before transmyocardial laser reperfusion (TMLR), when aortic declamping and 3, 6, 24 hours after operation. RESULTS: The level of proinflammatory factors increased more significantly after operation than before operation. TNF-alpha increased more significantly in the patients with CPB than in those without CPB after operation (4.10 +/- 0.71) pg/ml vs. (1.34 +/- 0.29) pg/ml, P < 0.05)]. IL-6 was not the different among all groups after operation. CRP was higher in the CAD patients with CPB than in the control group after operation (12.89 +/- 0.29) pg/ml vs. (12.00 +/- 0.31) pg/ml, P < 0.05]. CONCLUSION: Inflammatory response can be seen after operation in all CAD patients. In patients undergoing CABG without CPB or undergoing TMLR, the changes in flammatory response are milder than those in patients with CPB. Thus patients should undergo CABG without CPB if they are indicated.