Department of Cardiac Surgery, Kartal Kosuyolu Heart and Research Center, Istanbul, Turkey.
Artif Organs. 2011 Feb;35(2):131-6. doi: 10.1111/j.1525-1594.2010.01041.x.
The purpose of this study is to compare the effects of cardiopulmonary bypass (CPB) on the endothelium-derived nitric oxide (NO) levels in on-pump and off-pump coronary artery bypass surgeries. Forty consecutive patients were divided randomly into two groups depending on use of CPB in coronary artery bypass graft surgery (group 1: n = 20, off-pump, and group 2: n = 20, on-pump). The plasma endothelium-derived NO levels were determined at baseline and after reactive hyperemia before and after surgery. Reactive hyperemia was induced by inflating a blood pressure cuff placed on the upper forearm, for 5 min at 250 mm Hg followed by a rapid deflation. Blood was collected at 1 min after cuff deflation from the radial artery on the same side. Preoperative use of all medications was recorded. The baseline plasma NO levels before operation were 17.10 ± 7.58 in group 1 and 15.49 ± 5.26 nmol/L in group 2. Before operation after reactive hyperemia, the plasma NO levels were 26.97 ± 11.49 in group 1 and 26.57 ± 12.87 nmol/L in group 2. Two hours after surgery, the plasma NO levels at baseline and after reactive hyperemia were not significantly different from each other (group 1: 18.03 ± 6.37 and group 2: 19.89 ± 9.83 nmol/L; group 1: 27.89 ± 18.36 and group 2: 39.13 ± 23.60 nmol/L, respectively; P > 0.05). A positive correlation was shown between preoperative nitroglycerine use and the postoperative plasma NO levels after reactive hyperemia (r = 0.51, P = 0.001). Linear regression analysis was performed (F = 4.10, R = 0.56, R(2) = 0.32, P = 0.008) and the only independent parameter that had an effect on postoperative plasma NO levels after reactive hyperemia was found to be preoperative nitroglycerine use (t = 3.68, P = 0.001). Coronary artery bypass surgery with CPB does not have significant effect on plasma endothelial derived NO levels. The postoperative plasma NO levels after reactive hyperemia significantly correlated with preoperative nitroglycerine use.
本研究旨在比较体外循环（CPB）对体外循环和非体外循环冠状动脉旁路移植术患者内皮衍生一氧化氮（NO）水平的影响。连续 40 例患者根据冠状动脉旁路移植术时 CPB 的使用情况随机分为两组（组 1：n=20，非体外循环；组 2：n=20，体外循环）。分别于术前、术后及术后即刻测定两组患者肱动脉内皮衍生一氧化氮水平。通过对患者同侧的肱动脉充气至 250mmHg，持续 5min 诱导反应性充血，然后迅速放气。放气后 1min 从桡动脉采血。记录术前所有药物的使用情况。组 1 患者术前血浆 NO 水平为 17.10±7.58nmol/L，组 2 患者术前血浆 NO 水平为 15.49±5.26nmol/L。反应性充血后，组 1 患者术前、术后即刻血浆 NO 水平分别为 26.97±11.49nmol/L和 26.57±12.87nmol/L；组 2 患者术前、术后即刻血浆 NO 水平分别为 26.97±11.49nmol/L和 26.57±12.87nmol/L。术后 2h 时，两组患者基础状态和反应性充血后的血浆 NO 水平与术前比较差异均无统计学意义（组 1：18.03±6.37 和 19.89±9.83nmol/L；组 2：18.03±6.37 和 19.89±9.83nmol/L；组 1：27.89±18.36 和 29.13±23.60nmol/L；组 2：27.89±18.36 和 29.13±23.60nmol/L；P均>0.05）。术前使用硝酸甘油与术后反应性充血后血浆 NO 水平呈正相关（r=0.51，P=0.001）。行线性回归分析（F=4.10，R=0.56，R2=0.32，P=0.008），发现仅术前使用硝酸甘油是影响术后反应性充血后血浆 NO 水平的独立因素（t=3.68，P=0.001）。体外循环冠状动脉旁路移植术对血浆内皮衍生一氧化氮水平无显著影响。术后反应性充血后血浆 NO 水平与术前使用硝酸甘油显著相关。
