冠状动脉血运重建术后伴或不伴体外循环的炎症反应。

Inflammatory response after coronary revascularization with or without cardiopulmonary bypass.

作者信息

Ascione R, Lloyd C T, Underwood M J, Lotto A A, Pitsis A A, Angelini G D

机构信息

Bristol Heart Institute, Bristol Royal Infirmary, United Kingdom.

出版信息

Ann Thorac Surg. 2000 Apr;69(4):1198-204. doi: 10.1016/s0003-4975(00)01152-8.

DOI:10.1016/s0003-4975(00)01152-8

PMID:10800819

Abstract

BACKGROUND

We sought to investigate the effect of multiple coronary artery bypass grafting (CABG) with or without cardiopulmonary bypass (CPB) on the perioperative inflammatory response.

METHODS

Sixty patients undergoing CABG were randomly assigned to one of two groups: (A) on pump with conventional CPB and cardioplegic arrest, and (B) off pump on the beating heart. Serum samples were collected for estimation of neutrophil elastase, interleukin 8 (IL-8), C3a, and C5a preoperatively and at 1, 4, 12, and 24 hours postoperatively. Furthermore, white blood cell (WBC), neutrophil, and monocyte counts were carried out preoperatively and at 1, 12, 36 and 60 hours postoperatively. Overall incidence of infection and perioperative clinical outcome were also recorded.

RESULTS

The groups were similar in terms of age, weight, gender ratio, extent of coronary disease, left ventricular function, and number of grafts per patient. Neutrophil elastase concentration peaked early after CPB in the on-pump group, with a decline with time. Repeated-measures analysis of variance between groups and comparisons at each time point (modified Bonferroni) showed elastase concentrations were significantly higher in the on-pump than the off-pump group (both p < 0.0001). IL-8 increased significantly after surgery in the on-pump group, with no decline during the observation period (p = 0.01 vs off pump). C3a and C5a rose early after surgery in both groups when compared with baseline values. Postoperative WBC, neutrophil, and monocyte counts were significantly higher in the on-pump than the off-pump group (p < 0.01). Finally, the incidence of postoperative overall infections was significantly higher in the on-pump group (p < 0.0001 vs off pump).

CONCLUSIONS

CABG on the beating heart is associated with a significant reduction in inflammatory response and postoperative infection when compared with conventional revascularization with CPB and cardioplegic arrest.

摘要

背景

我们试图研究在有或没有体外循环（CPB）的情况下进行多次冠状动脉旁路移植术（CABG）对围手术期炎症反应的影响。

方法

60例行CABG的患者被随机分为两组：（A）采用传统CPB和心脏停搏的体外循环组，（B）不停跳心脏非体外循环组。术前及术后1、4、12和24小时采集血清样本，用于检测中性粒细胞弹性蛋白酶、白细胞介素8（IL-8）、C3a和C5a。此外，术前及术后1、12、36和60小时进行白细胞（WBC）、中性粒细胞和单核细胞计数。记录总体感染发生率和围手术期临床结局。

结果

两组在年龄、体重、性别比例、冠心病程度、左心室功能和每位患者的移植血管数量方面相似。体外循环组中性粒细胞弹性蛋白酶浓度在CPB后早期达到峰值，随后随时间下降。组间重复测量方差分析及各时间点比较（修正Bonferroni法）显示，体外循环组弹性蛋白酶浓度显著高于非体外循环组（均p<0.0001）。体外循环组术后IL-8显著升高，观察期内未下降（与非体外循环组相比，p=0.01）。与基线值相比，两组术后C3a和C5a均在术后早期升高。体外循环组术后WBC、中性粒细胞和单核细胞计数显著高于非体外循环组（p<0.01）。最后，体外循环组术后总体感染发生率显著高于非体外循环组（与非体外循环组相比，p<0.0001）。