Gu Y J, Mariani M A, van Oeveren W, Grandjean J G, Boonstra P W
Department of Cardiothoracic Surgery, Thorax Center, University Hospital, Groningen, The Netherlands.
Ann Thorac Surg. 1998 Feb;65(2):420-4. doi: 10.1016/s0003-4975(97)01127-2.
The aim of this prospective study was to determine whether the inflammation-associated clinical morbidity as well as the subclinical markers of the inflammatory response are reduced in patients who undergo minimally invasive coronary artery bypass grafting without cardiopulmonary bypass.
From June 1995 to June 1996, 62 consecutive patients with isolated stenosis of the left anterior descending coronary artery were assigned randomly to two groups: 31 patients underwent minimally invasive coronary artery bypass grafting and 31 patients underwent conventional coronary artery bypass grafting with cardiopulmonary bypass. In a subgroup of 10 patients in each group, subclinical markers were measured to determine the level of the inflammatory response generated during the operation.
In the group that underwent minimally invasive coronary artery bypass grafting, leukocyte elastase, platelet beta-thromboglobulin, and complement C3a were unchanged at the end of the procedure compared with their baseline concentrations, whereas these inflammatory markers were increased significantly in the group that underwent conventional coronary artery bypass grafting with cardiopulmonary bypass. The patients who underwent minimally invasive coronary artery bypass grafting had a shorter duration of operation (104 +/- 28 versus 140 +/- 28 minutes; p < 0.01), less blood loss (312 +/- 167 versus 788 +/- 365 mL; p < 0.01), shorter ventilatory support (7.7 +/- 4.1 versus 12.9 +/- 3.4 hours; p < 0.01), and a shorter postoperative hospital stay (4.4 +/- 1.7 versus 7.7 +/- 2.6 days; p < 0.01) than the patients who underwent the conventional procedure.
These data suggest that patients who undergo minimally invasive coronary artery bypass grafting have a significant reduction in the systemic inflammatory response, postoperative morbidity, and hospital stay compared with patients who undergo conventional coronary artery bypass grafting with cardiopulmonary bypass.
这项前瞻性研究的目的是确定在接受非体外循环下微创冠状动脉旁路移植术的患者中，与炎症相关的临床发病率以及炎症反应的亚临床标志物是否会降低。
从1995年6月至1996年6月，62例连续的左前降支冠状动脉孤立性狭窄患者被随机分为两组：31例患者接受非体外循环下微创冠状动脉旁路移植术，31例患者接受体外循环下传统冠状动脉旁路移植术。在每组10例患者的亚组中，测量亚临床标志物以确定手术期间产生的炎症反应水平。
与基线浓度相比，接受非体外循环下微创冠状动脉旁路移植术的组在手术结束时白细胞弹性蛋白酶、血小板β-血小板球蛋白和补体C3a未发生变化，而在接受体外循环下传统冠状动脉旁路移植术的组中，这些炎症标志物显著升高。接受非体外循环下微创冠状动脉旁路移植术的患者手术时间较短（104±28对140±28分钟；p<0.01），失血量较少（312±167对788±365毫升；p<0.01），通气支持时间较短（7.7±4.1对12.9±3.4小时；p<0.01），术后住院时间较短（4.4±1.7对7.7±2.6天；p<0.01）。
这些数据表明，与接受体外循环下传统冠状动脉旁路移植术的患者相比，接受非体外循环下微创冠状动脉旁路移植术的患者全身炎症反应、术后发病率和住院时间显著降低。
