Wen S, Wang J, Zhang C
Beijing Institute of Heart, Lung & Blood Vessel Diseases, Beijing Anzhen Hospital, Beijing 100029, China.
Zhonghua Yi Xue Za Zhi. 2001 Dec 10;81(23):1450-2.
To observe the dynamic changes of tumor necrosis factor-alpha(TNF-alpha) and endothelin (ET-1) during perioperative period in patients undergoing coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB) and to investigate their pathological significance so as to bring up feasible measure to increase therapeutic effect.
Blood samples of 32 patients undergoing CABG with CPB were drawn before operation, induction period of anaesthesia, after aortic crossclamping and declamping, by the end of surgery, and 2 hours, 8 hours, and 24 hours after surgery. The plasma TNF-alpha and ET-1 were measured by radioimmunoassay (RIA).
(1) The plasma TNF-alpha level increased markedly after aortic crossclamping (18.3 ng/L +/- 3.4 ng/L vs 12.1 ng/L +/- 2.0 ng/L, P < 0.05) and went up to the peak value(22.4 ng/L +/- 3.6 ng/L) after aortic declamping, and then decreased. However, till 24 hours after operation, the TNF-alpha concentration maintained at a level higher than that before surgery (18.5 ng/L +/- 4.1 ng/L vs 12.1 ng/L +/- 2.0 ng/L, P < 0.05. After aortic declamping, during reperfusion of the lungs the TNF-alpha level was significantly higher than that after aortic crossclamping and before declamping (22.4 ng/L +/- 3.6 ng/L vs 18.3 ng/L +/- 3.4 ng/L P < 0.05). (2) The plasma ET-1 increased significantly after aortic crossclamping (146 ng/L +/- 20 ng/L vs 97 ng/L +/- 14 ng/L, P < 0.05) and went down after aortic declamping. Two hours after surgery, the plasma ET-1 increased again and reached the second height (134 ng/L +/- 19 ng/L), and then went down again and decreased to 92 ng/L +/- 18 ng/L 24 h after operation.
(1) Attenuation of inflammatory reactions mediated by TNF-alpha should be considered an important strategy for myocardial and lung protection. (2) During the perioperative period of CABG the plasma ET-1 level shows two peaks, occurring respectively after aortic crossclamping and 2 h after surgery, which may result from operation itself and ischemia-reperfusion injury.
观察冠状动脉旁路移植术（CABG）体外循环（CPB）患者围手术期肿瘤坏死因子-α（TNF-α）和内皮素（ET-1）的动态变化，探讨其病理意义，以提出提高治疗效果的可行措施。
选取32例行CABG并使用CPB的患者，于术前、麻醉诱导期、主动脉阻断和开放后、手术结束时以及术后2小时、8小时和24小时采集血样。采用放射免疫分析法（RIA）测定血浆TNF-α和ET-1水平。
（1）主动脉阻断后血浆TNF-α水平显著升高（18.3 ng/L±3.4 ng/L比12.1 ng/L±2.0 ng/L，P<0.05），主动脉开放后升至峰值（22.4 ng/L±3.6 ng/L），随后下降。然而，直至术后24小时，TNF-α浓度维持在高于术前的水平（18.5 ng/L±4.1 ng/L比12.1 ng/L±2.0 ng/L，P<0.05）。主动脉开放后，肺再灌注期间TNF-α水平显著高于主动脉阻断后及开放前（22.4 ng/L±3.6 ng/L比18.3 ng/L±3.4 ng/L，P<0.05）。（2）主动脉阻断后血浆ET-1显著升高（146 ng/L±20 ng/L比97 ng/L±14 ng/L，P<0.05），主动脉开放后下降。术后2小时，血浆ET-1再次升高并达到第二个高峰（134 ng/L±19 ng/L），随后再次下降，术后24小时降至92 ng/L±18 ng/L。
（1）减轻TNF-α介导的炎症反应应被视为心肌和肺保护的重要策略。（2）在CABG围手术期，血浆ET-1水平出现两个峰值，分别出现在主动脉阻断后和术后2小时，这可能是由手术本身及缺血再灌注损伤所致。
