Heart Institute (InCor), Medical School, University of São Paulo, Brazil 05403-901.
J Crit Care. 2010 Jun;25(2):305-12. doi: 10.1016/j.jcrc.2009.06.009. Epub 2009 Sep 24.
The effects of off-pump (OffPCABG) and on-pump (OnPCABG) coronary artery bypass grafting (CABG) on myocardium and inflammation are unclear.
Compare the inflammatory response and myocardial injury from patients (pts) submitted to OffPCABG with those that undergo OnPCABG.
Patients with normal left ventricular function were assigned to OffPCABG (n = 40) and OnPCABG (n = 41). Blood samples were collected before and 24 hours after surgery for determination of creatine kinase (CK)-MB (CK-MB), troponin I (cTnI), interleukin (IL)-6, IL-8, P-selectin, intercellular adhesion molecule (ICAM)-1 and C-reactive protein (CRP). Mortalities were registered at 12 months.
Preoperative CK-MB and cTnI levels were 3.1 +/- 0.6 IU and 1.2 +/- 0.5 ng/mL for OffPCABG and 3.0 +/- 0.5 IU and 1.0 +/- 0.2 ng/mL for OnPCABG pts. Postoperative CK-MB and cTnI levels were 13.9 +/- 6.5 IU and 19.0 +/- 9.0 ng/mL for OffPCABG vs 29.5 +/- 11.0 IU and 31.5 +/- 10.1 ng/mL for OnPCABG (P < .01). OffPCABG and OnPCABG pts had similar preoperative IL-6 (10 +/- 7 and 9 +/- 13 pg/mL), IL-8 (19 +/- 7 and 17 +/- 7 pg/mL), soluble P-selectin (70 +/- 21 and 76 +/- 23 pg/mL), soluble ICAM-1 (117 +/- 50 and 127 +/- 52 ng/mL), and CRP (0.09 +/- 0.05 and 0.11 +/- 0.07 mg/L). At 24 hours, for OffPCABG and OnPCABG: IL-6 was 37 +/- 38 and 42 +/- 41 g/mL; IL-8, 33 +/- 31 and 60 +/- 15 pg/mL; soluble P-selectin, 99 +/- 26 and 172 +/- 30 pg/mL; soluble ICAM-1, 227 +/- 47 and 236 +/- 87 ng/mL; and CRP, 10 +/- 11 and 14 +/- 13 mg/L (P < .01 vs preoperation; P < .01 vs OffPCABG). Increased 24-hour postoperative CRP levels was the only marker to have significant positive correlations with events and occurred just for the OnPCABG pts. In-hospital and 1-year mortalities for the OnPCABG and OffPCABG pts were 2.0% and 2.2% (P = .1) and 2.7% and 4.7% (P = .06), respectively.
Thus, the absence of CPB during CABG preserves better the myocardium and attenuates inflammation-however, without improving survival.
非体外循环（OffPCABG）和体外循环（OnPCABG）冠状动脉旁路移植术（CABG）对心肌和炎症的影响尚不清楚。
比较接受 OffPCABG 和 OnPCABG 的患者的炎症反应和心肌损伤。
将左心室功能正常的患者分为 OffPCABG（n=40）和 OnPCABG（n=41）组。分别于术前和术后 24 小时采集血样，测定肌酸激酶同工酶（CK-MB）、肌钙蛋白 I（cTnI）、白细胞介素（IL）-6、IL-8、P-选择素、细胞间黏附分子（ICAM）-1 和 C 反应蛋白（CRP）。登记 12 个月的死亡率。
OffPCABG 和 OnPCABG 患者术前 CK-MB 和 cTnI 水平分别为 3.1+/-0.6IU 和 1.2+/-0.5ng/mL 和 3.0+/-0.5IU 和 1.0+/-0.2ng/mL。OffPCABG 和 OnPCABG 患者术后 24 小时 CK-MB 和 cTnI 水平分别为 13.9+/-6.5IU 和 19.0+/-9.0ng/mL 与 29.5+/-11.0IU 和 31.5+/-10.1ng/mL（P<.01）。OffPCABG 和 OnPCABG 患者术前 IL-6（10+/-7 和 9+/-13pg/mL）、IL-8（19+/-7 和 17+/-7pg/mL）、可溶性 P-选择素（70+/-21 和 76+/-23pg/mL）、可溶性 ICAM-1（117+/-50 和 127+/-52ng/mL）和 CRP（0.09+/-0.05 和 0.11+/-0.07mg/L）相似。术后 24 小时，OffPCABG 和 OnPCABG 患者的 IL-6 分别为 37+/-38 和 42+/-41pg/mL；IL-8 为 33+/-31 和 60+/-15pg/mL；可溶性 P-选择素为 99+/-26 和 172+/-30pg/mL；可溶性 ICAM-1 为 227+/-47 和 236+/-87ng/mL；CRP 为 10+/-11 和 14+/-13mg/L（P<.01与术前；P<.01与 OffPCABG）。仅在 OnPCABG 患者中，术后 24 小时升高的 CRP 水平是唯一与事件有显著正相关的标志物，仅发生在 OnPCABG 患者中。OnPCABG 和 OffPCABG 患者的住院死亡率和 1 年死亡率分别为 2.0%和 2.2%（P=0.1）和 2.7%和 4.7%（P=0.06）。
因此，CABG 时不使用 CPB 可更好地保护心肌并减轻炎症反应，但不能提高生存率。
