冠心病围术期肾素-血管紧张素-醛固酮系统变化的研究  

The study of RAAS and hemodynamics during perioperative coronary artery disease

作　　者：李京倖[1] 顾承雄[1] 黄方炯[1] 屈正[1] 尤斌[1] 孔晴宇[1] 

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所心外科,100029

出　　处：《心肺血管病杂志》2009年第4期229-232,共4页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:研究冠心病围术期肾素-血管紧张素(RAAS)及血流动力学变化规律。方法:37例冠心病分为5组。组1冠状动脉旁路移植术(CABG)+室壁瘤切除,组2体外循环(CPB)下CABG,组3非体外循环下的冠状动脉旁路移植术(OPCABG),组4激光心肌打孔组(TMLR)。用放免法测术前,主动脉阻断前(搭桥前或打孔前),开放时(搭桥结束时或打孔后),开放后3,6及24 h血管紧张素Ⅱ(AGⅡ)、醛固酮(ALD)和血流动力学指标。收集0～6 h、6～24 h尿钾总量。结果:AGⅡ:组1,2主动脉开放时,开放后3,6及24 h显著高于术前(P<0.05)。组间:组2术后3 h显著高于组3(P<0.05)。ALD组内:组1,2主动脉开放时,开放后3 h显著高于术前(P<0.05)。组间:组2开放时、术后3 h显著高于组3(P<0.05)。术后各组心排指数(CI)较术前明显增加(P<0.05)。尿钾:术后各组间尿钾排出总量差异无统计学意义。结论:冠心病术后早期RAAS活性升高,使用CPB的患者,升高更明显,但24 h以内恢复正常。冠心病行OPCABG,术后心功能恢复快,全身反应轻,如有适应症应积极选用此术式。TMLR患者全身反应,是冠心病外科治疗的有益补充。Objective： Renin-Angiotensin-Aldosterone system （RAAS） and hemodynamics parameters were studied during perioperative coronary artery disease（CAD） with different treatments, such as coronary artery bypass grafting（CABG） with cardiopulmonary bypass （CPB） or without CPB or transmyocardial laser revascularization （TMLR）, in order to detect some difference in CABG among these treatments. Method： Thirty-seven patients were studied. They were divided into 4 groups. Group 1 ： CABG ＋ Aneurysm. Group 2 ： classical CABG, CABG with CPB. Group 3 ： Off-pump CABG （ OPCABG）. Group 4 ： TMLR. Angiotensin Ⅱ （ AG Ⅱ） and Aldosterone （AID） were measured by radioimmunoassay in the following time： before operation, before revascularization （before aortic clamping）, just after revascularization （aortic declamping）, 3, 6 and 24 hours after revascularization. In the meantime, hemodynamic parameters were measured before operation, 3, 6, and 24 hours after operation, respectively. Result：AG Ⅱ ： in group 1 and 2, it increased significantly after operation（ P 〈 0.05）. In group 3 and 4, there is no difference before and after operation. The AG Ⅱ level was higher in group 2 than in group 3 in 3 hours after operation（ P 〈 0.05）. ALD： in group land 2, it increased significantly when declamping the aorta, and in 3 hours after operation（P 〈 0.05）. ALD level was higher in group 2 than in group 3 in the end of CABG and 3 hours after operation（ P 〈 0.05）. Total Urinous Potassium： There was no difference among groups during 0-6,6-24 hours after operation. Conclusion： The changes of the neurohormonal factors in CABG with CPB are much more than those without CPB and in TMLR. But the changes resulted by CPB are temporary and acceptable. To the patients undergoing OPCABG, the heart function recovers quickly. Thus it is better that the patients undergo OPCABG if the indications are suitable. TMLR is a good and useful supplement for CAD therapy.

关 键 词：冠状动脉疾病 冠状动脉旁路移植术 体外循环 激光心肌打孔 血管紧张素 

分 类 号：R543.3[医药卫生—心血管疾病]