不同方式冠状动脉旁路移植术后炎性因子对比探究.docVIP

不同方式冠状动脉旁路移植术后炎性因子对比探究 　【摘要】 目的 对比研究体外循环下冠状动脉旁路移植术（CCABG）和非体外循环下冠状动脉旁路移植术（OPCAB）围手术期炎性因子变化规律。方法 42例不稳定心绞痛患者随机分为CCABG组（20例）和OPCAB组（22例） ；分别于麻醉诱导后、再灌注后5 min、术后第 2 h、4 h、12 h、24 h经桡动脉采取血样标本，使用放射免疫法分别测定每份标本中肿瘤坏死因子-α（TNF-α）、白介素（IL）-6、IL-8和IL-10的浓度。结果 两组患者术前血浆TNF-α、IL-6、IL-8和IL-10水平无显著性差异，CCABG组术后TNF-α、IL-6、IL-8和IL-10水平明显升高，而OPCAB组术后血浆中只有IL-6和IL-8水平较术前明显升高；两组相比，CCABG组TNF-α、IL-8和IL-10血浆水平高于OPCAB组，差异有显著性（Plt;0.05）。结论 体外循环是导致CCABG术后炎性反应的主要因素。 【关键词】 体外循环；冠状动脉旁路移植术；炎性因子； 　　　Abstract: OBJECTIVE To invest the relation between perioperative inflammatory response and extracorporeal circulation(ECC) by comparing the perioperative release levels of inflammatory cytokines and myocardial tissue injury between conventional coronary artery bypass grafting(CCABG) and off-pump coronary artery bypass grafting(OPCAB). METHODS Forty-two patients with instable angina underwent coronary artery bypass grafting were randomly divided into two group: CCABG group (20 cases) and OPCAB group (22 cases). In all patients, blood samples were collected from the radial artery after induction of anesthesia and 5 min, 2 h,4 h,12 h and 24 h after reperfusion to measure the serum levels of tumor necrosis factor (TNF)-α，interleukin (IL)-6，IL-8 and IL-10 by radioimmunoassay method. RESULTS The basic levels of TNF-α,IL-6,IL-8 and IL-10 two groups were similar.After surgery, the levels of TNF-α，IL-6，IL-8 and IL-10 increased remarkably in CCABG of group, whereas only IL-6 and IL-8 increased significantly in OPCAB group,and there were significant differences of TNF-α，IL-8，IL-10 between two groups（Plt;0.05）. CONCLUSION ECC might be the major factors inducing inflammatory response after CCABG. 　　Key words： Extracorporeal circulation; CABG; Inflammatory cytokines 　　为了客观地比较体外循环下冠状动脉旁路移植术（CCABG）和非体外循环下冠状动脉旁路移植术（OPCAB）对机体的影响，本研究对CCABG术和OPCAB术的患者围手术期血浆肿瘤坏死因子-α（TNF-α）、白介素（IL）-6、IL-8、IL-10进行了动态检测，以明确二种手术方法引起的炎性反应差异。 　　1 资料与方法 　　1.1 临床资料 选择42例冠状动脉多支病变，需接受第一次CCABG的患者。所选患者均无瓣膜疾病、感染性疾病和服用类固醇激素，OPCAB组22例， CCABG组20例。手术为完全再血管化并由同