非体外循环冠状动脉旁路移植术中血液回输对围手术期的影响  

Effect of pericardial suction blood re-transfusion in off-pump coronary artery bypass grafting on inflammatory cytokines, myocardial injury and pulmonary function

作　　者：李培军[1] 魏民新[1] 刘建实[1] 张燕杰[1] 赵丰[1] 张凯[1] 孟冬梅[1] 

机构地区：[1]天津市胸科医院心脏外科,300051

出　　处：《中华外科杂志》2008年第9期677-680,共4页Chinese Journal of Surgery

基　　金：天津市自然科学基金资助项目（043613011、05YFSZSF02700）

摘　　要：目的研究非体外循环冠状动脉旁路移植术（CABG）术中血液回输与术后血浆细胞因子水平的关系及对心肌损害、肺功能的影响。方法将患者分为三组：非体外循环CABG术中回输血量≥600ml为OPCABG1组（16例），〈600ml为OPCABG2组（15例）；心肺转流下CABG作为对照组（13例）。分别于术前，术后1、4、24和72h取静脉血，采用液相芯片法检测细胞因子IL-6、IL-8、IL-10和TNF-α，并记录CK-MB、TnI、AaDO2、PaO2／FiO2的变化。结果三组患者的一般情况、既往史、射血分数、左心室舒张末期内径、冠状动脉旁路数量、术中出血量均无差异。术中回输血量OPCABG1组（800．0±246．3）ml，OPCABG2组（276．0±136．9）ml。三组患者IL-6、IL-8、IL-10水平均于术后1h达到峰值，并于术后72h恢复到术前水平。术后1h，CABG组和OPCABG1组IL-6、IL-8的水平均高于OPCABG2组（P〈0．05）。CABG组术后4h的CK—MB、TnI水平及术后24hTnI水平均高于OPCABG1组和OPCABG2组（P〈0．05）。三组间同一时间点AaD02、PaO2／FiO2差异均无显著性意义（P〉0．05）。结论OPCABG中的大量血液回输会提高血浆细胞因子IL-6、IL-8的水平，但尚不足以引起显著的心肌损害并影响肺换气功能。Objective To investigate the effect of pericardial suction blood re-transfusion in offpump coronary artery bypass grafting （CABG） on inflammatory cytokines, myocardial injury and lung function. Methods 31 patients of off-pump CABG were divided into two study groups （ OPCABG1 group and OPCABG2 group） according to the amount of pericardial suction blood re-transfuslon beyond or less than 600 ml. 13 patients of on-pump CABG were control group. Serum samples from vein were collected for measurement of IL-6, IL-8, IL-10 and TNF-α pre-operation and 1, 4, 24, 48 hours post-operation respectively. The results of CK-MB, TnI, AaDO2 and PaO2/FiO2 were recorded. Results Patients of the three groups had no significant difference in terms of gender, age, bedyweight, history of hypertension and cardiac infarction and diabetes, EF and left ventricular end diastolic of pre-operation, the amount of bypass graft and shed blood. Of the three groups, IL-6, IL-8 and IL-10 reached peak level one hour after the operation, and dropped to the pre-operation level 72 hours after the operation. One hour after the operation, the level of IL-6 and IL-8 in OPCABG1 group was higher than in OPCABG2 group （ P 〈0. 05 ） and about the same in CABG group （ P 〉 0. 05 ）. Four hours after the operation, the level of CK-MB in OPCABG1 group was lower than that of CABG group （ P 〈 0. 05 ） and about the same in OPCABG2 group （ P 〉 0. 05 ）. 4 and 24 hours after the operation, the level of TnI in OPCABG1 group was lower than that of CABG group （ P 〈 O. 05 ） and about the same in OPCABG2 group （ P 〉 0.05 ） . Among the three groups, there was no significant difference in AaDO2 and PaO2/FiO2. Conclusions Re-transfusion of large amount of pericardial suction blood can increase serum level of IL-6, IL-8, but it can not cause myocardial injury and affect the gas exchange function of lung significantly.

关 键 词：冠状动脉旁路移植术 非体外循环 心肺转流术 细胞因子类 肌酸激酶 MB型 

分 类 号：R654.2[医药卫生—外科学] R457.1[医药卫生—临床医学]