Hartford Hospital, CT 06102, USA.
Am J Health Syst Pharm. 2011 Sep 1;68(17):1632-9. doi: 10.2146/ajhp100703.
The effect of ascorbic acid on inflammatory markers after cardiothoracic surgery (CTS) was studied.
In this randomized, double-blind, placebo-controlled trial, patients undergoing cardiopulmonary bypass graft surgery or valve replacement surgery from April 2009 through March 2010 at Hartford Hospital were randomized to receive ascorbic acid (2-g loading dose followed by 500 mg every 12 hours) or matching placebo the evening before surgery and for four days postoperatively. Inflammatory mediators were measured preoperatively and on postoperative days 1-4. Intergroup comparisons were performed using two-tailed t tests and Fisher's exact test. Multiple comparisons were conducted using repeated analyses of variance with Bonferroni tests.
Of the 62 patients screened, 24 met the study inclusion criteria. Of these, 13 were assigned to receive ascorbic acid and 11 received placebo. Ascorbic acid did not affect the natural course of inflammatory marker rise for C-reactive protein (CRP) concentration, white blood cell (WBC) count, or fibrinogen concentration versus placebo at any evaluated time point (p > 0.05 for all intergroup comparisons). Intragroup analyses demonstrated significant differences among baseline and postoperative measures of all inflammatory mediators (p < 0.05). No significant differences were noted in inflammatory markers between patients undergoing cardiothoracic surgery with or without cardiopulmonary bypass, regardless of treatment group.
Ascorbic acid did not attenuate the rise in inflammatory markers after CTS when compared with placebo. The use of off-pump surgery did not significantly change the levels of CRP and fibrinogen or the WBC count postoperatively when compared with on-pump surgery with a biocompatible polymer coating.
研究抗坏血酸对心胸外科手术后（CTS）炎症标志物的影响。
这是一项随机、双盲、安慰剂对照试验，于 2009 年 4 月至 2010 年 3 月期间在哈特福德医院接受体外循环搭桥手术或瓣膜置换手术的患者，被随机分为接受抗坏血酸（负荷剂量 2 g，随后每 12 小时 500 mg）或匹配安慰剂，在手术前一晚和术后 4 天内使用。在术前和术后第 1-4 天测量炎症介质。使用双尾 t 检验和 Fisher 确切检验进行组间比较。使用重复方差分析和 Bonferroni 检验进行多组比较。
在筛选的 62 名患者中，有 24 名符合研究纳入标准。其中 13 名患者接受抗坏血酸治疗，11 名患者接受安慰剂治疗。与安慰剂相比，抗坏血酸在任何评估时间点均未影响 C-反应蛋白（CRP）浓度、白细胞（WBC）计数或纤维蛋白原浓度的炎症标志物自然升高过程（所有组间比较 p > 0.05）。组内分析显示，所有炎症介质的基线和术后测量均有显著差异（p < 0.05）。无论治疗组如何，行或不行体外循环的心胸外科手术患者的炎症标志物均无显著差异。
与安慰剂相比，抗坏血酸不能减轻 CTS 后炎症标志物的升高。与使用生物相容性聚合物涂层的体外循环相比，非体外循环手术并未显著改变 CRP 和纤维蛋白原或术后白细胞计数的水平。
