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体外膜肺氧合辅助不停跳冠状动脉旁路移植术对炎性因子的影响

魏锦   

  1. 天津市第三中心医院（寄家里）
  • 收稿日期:2011-08-25 修回日期:2011-12-07 出版日期:2012-05-15 发布日期:2012-05-15
  • 通讯作者: 魏锦

The changes of Inflammatory Factors Due to ECMO Assisted Beating Heart CABG

  • Received:2011-08-25 Revised:2011-12-07 Published:2012-05-15 Online:2012-05-15

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摘要： 目的：研究体外膜肺氧合(ECMO)辅助不停跳冠状动脉旁路移植术(CABG)对炎性因子的影响，并与常规体外循环(CCABG)及非体外循环冠状动脉旁路移植术(OPCABG)比较，观察ECMO辅助不停跳手术是否有优越性。方法：对45例冠心病患者行CABG，分为3组：CCABG组，ECMO辅助不停跳组和OPCABG组，每组15例。每例患者均在麻醉诱导前(T1) 、转流或开胸后10min(T2) 、停机后/术后即刻(T3) 、术后4h(T4) 、术后24h(T5) 分别取血，分离出血浆， 以酶联免疫吸附法(ELISA)检测肿瘤坏死因子α(TNF-α)，白介素6(IL-6)和白介素8(IL-8)，观察其变化规律。结果：ECMO辅助不停跳组的患者年龄明显高于其他两组，差异有统计学意义(P<0.05)。 3组患者炎性因子血浆浓度均较术前显著升高(P <0.05)，并在术后4h内达到高峰，直到术后24 h仍在较高水平。在术后即刻，ECMO辅助不停跳组和OPCABG组TNF-α，IL-6，IL-8浓度远远低于CCABG组，差异有统计学意义(P<0.05)，术后4h及24h3组比较，无明显差异(P>0.05)。结论：虽然ECMO辅助不停跳手术在炎性反应变化没有明显的优势，但由于ECMO辅助不停跳组的患者选择均为高龄危重患者，为高龄危重患者手术开辟了一条新的救治途径。

关键词: 体外膜肺氧合, 炎性介质, 冠状动脉旁路移植术, 冠心病, 体外循环

Abstract: Objective: To investigate the impact of extracorporeal membrane oxygenation(ECMO) assisted beating heart coronary artery bypass graft(CABG) on inflammatory factors, and compare it with conventional coronary artery bypass graft (CCABG) and off-pump coronary artery bypass graft(OPCABG). Method: 45 patients with coronary artery disease undergo CABG were divided into three groups: CCABG group, ECMO assisted CABG group and OPCABG group, for each group 15 patients. The blood samples were collected from peripheral vein at the moment preanesthesia(T1) , 10 min after pump or ECMO starting 10 min(T2) , pump or ECMO stopped or surgery finished moment(T3) , 4th hour after surgery(T4) and 24th hour after surgery(T5) . Centrifuged blood samples for plasma. Observe the change patterns of inflammatory cytokines tumor necrosis factor-α(TNF-α), interleukin-6(IL-6) and interleukin-8 (IL-8) measured by enzyme-linked immune sorbent assay(ELISA). Result: The patient ages were significantly higher in ECMO assisted group than the other two groups(P<0.05). There was significant plasma level increase of inflammatory factors since pump or ECMO starting compared with preanesthesia (P < 0.05), and they had reached peak before 4th hour after surgery, kept a high level even at 24th hour after surgery. At the moment after surgery, the plasma level of TNF-α，IL-6 and IL-8 was obviously lower in both ECMO assisted group and CCABG group(P<0.05), but after 4h there was no significant difference among three groups(P>0.05). Conclusion: Though there is no significant superiority compared ECMO assisted beating heart coronary artery bypass graft with other surgery methods, the patient ages are obviously higher in ECMO assisted group, and it may be a new surgery pathway for ageing patients.

Key words: Extracorporeal membrane oxygenation, Inflammatory factors, c Coronary artery bypass graft, c Coronary artery disease, Mini bypass