Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China.
Curr Opin Pharmacol. 2012 Apr;12(2):155-9. doi: 10.1016/j.coph.2012.01.007. Epub 2012 Feb 2.
A significant inflammatory response and subsequent organ dysfunction is known to be associated with the use of CPB. Pharmaceutical interventions, such as corticosteroids, statins and ACE-Is can attenuate the post-CPB inflammatory and immune response, by so doing, either directly or indirectly, reduce incidence of postoperative complications. Apart from its effects on lipids, statins have been found to reduce postoperative oxidative stress that may partly contribute towards improved graft patency. In addition, certain ACE-inhibitors can promote a pro-fibrinolytic environment, whose role on maintaining graft patency and clinical outcomes warrant further investigation. There is increasing evidence to support the use of combined clopidogrel with aspirin following CABG to improve graft patency, although its impact on reducing postoperative adverse events remains unclear. Factors such as drug bioavailability and individual variability in drug responses and metabolism of these antiplatelet agents can significantly influence clinical outcomes.
已知 CPB 的使用与明显的炎症反应和随后的器官功能障碍有关。药物干预，如皮质类固醇、他汀类药物和 ACE-Is，可以通过直接或间接的方式减轻 CPB 后的炎症和免疫反应，从而降低术后并发症的发生率。除了对脂质的影响外，他汀类药物还被发现可以减少术后氧化应激，这可能部分有助于改善移植物通畅性。此外，某些 ACE 抑制剂可以促进纤维蛋白溶解的环境，其在维持移植物通畅性和临床结果方面的作用值得进一步研究。越来越多的证据支持在 CABG 后使用氯吡格雷联合阿司匹林来改善移植物通畅性，尽管其对减少术后不良事件的影响尚不清楚。这些抗血小板药物的药物生物利用度和个体对药物反应和代谢的变异性等因素会显著影响临床结果。
