Interleukin-1, interleukin-6 and myocardial enzyme response after coronary artery bypass grafting - a prospective randomized comparison of the conventional and three minimally invasive surgical techniques
Interleukin-1, interleukin-6 and myocardial enzyme response after coronary artery bypass grafting - a prospective randomized comparison of the conventional and three minimally invasive surgical techniques
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DOI：
10.1016/s1010-7940(00)00553-4
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发表时间：
2000-11-01
影响因子：
3.4
通讯作者：
Schueler, S
中科院分区：
文献类型：
--
作者：
Gulielmos, V;Menschikowski, M;Schueler, S
目的：为评价胸骨正中切开和体外循环(CPB)在常规和微创冠状动脉旁路移植术中的创伤作用，对单支冠状动脉旁路移植术患者的炎症反应进行了前瞻性随机试验研究。方法：比较4种手术方法：第一组胸骨正中切开+CPB手术10例(男性8例，女性2例，平均年龄59.6±11.0岁)，第二组胸骨正中切开非体外循环手术10例(男性7例，女性3例，年龄65.1±10.0岁)，小切口CPB手术10例(男性7例，女性3例，年龄61.2±10.4岁；第4组：小切口非体外循环手术10例，男9例，女1例，年龄62.9±-3.8岁。所有患者均接受了左乳内动脉至左前降支(LAD)的移植。监测临床资料、围手术期细胞因子和心肌酶的变化。结果。没有发生重大并发症。体外循环过程中肌钙蛋白-T和肌酸激酶同工酶MB(CK-MB)水平显著升高(P<；0.0056；多变量一般线性模型)。白介素6(IL-6)水平在小切口手术中显著升高。所有患者的白介素1(IL-I)水平均较术前显著升高。结论：CPB联合肌钙蛋白-T和CK-MB水平升高是心肌损害的标志。手术入路被认为是炎症反应的触发因素，因为小切口与较高水平的IL-6有关。IL-1在所有手术中均升高，且这种升高与手术入路或CPB的使用无关，这表明炎症反应和麻醉之间存在潜在的关系。体外循环和手术途径均不影响冠状动脉单支血管搭桥术的临床结果。(C)2000 Elsevier Science B.V.保留所有权利。
Objective: In order to evaluate the traumatic effects of median sternotomy and cardiopulmonary bypass (CPB) in conventional and minimally invasive coronary artery bypass grafting, inflammatory response was studied in a prospective randomized trial in patients referred to single-vessel coronary artery bypass grafting. Methods: Four surgical techniques were compared: group I,median sternotomy with CPB in ten patients (eight male, two female; aged 59.6 +/- 11.0 years (mean +/- SDI); group 2, median sternotomy and off-pump in ten patients (seven male, three female, aged 65.1 +/- 10.0 years), group 3, minithoracotomy with CPB in ten patients (seven male, three female, aged 61.2 +/- 10.4 years!; group 4, minithoracotomy and off-pump in ten patients (nine male, one female, aged 62.9 +/- 3.8 years). All patients received a left internal mammary artery graft to the left anterior descending artery (LAD). Clinical data, perioperative values of cytokines and cardiac enzymes were monitored. Results. There were no major complications. Troponin-T and creatine kinase isoenzyme MB (CK-MB) levels were significantly higher in CPB procedures (P < 0.0056; multivariate general linear model). Interleukin-6 (IL-6) levels were significantly higher in minithoracotomy procedures. Interleukin-1 (IL-I) was significantly increased in all patients compared with the preoperative values. Conclusions: The use of CPB is combined with higher levels of troponin-T and CK-MB as signs of myocardial damage. Surgical access was identified as a trigger of inflammatory response, as minithoracotomy is related to higher levels of IL-6. IL-1 increased in ail procedures and this occurred independently of the surgical access or the use of CPB, which points out a potential relationship between inflammatory response and anesthesia. Neither CPB nor surgical access influenced the clinical outcome in the treatment of coronary artery single-vessel bypass grafting. (C) 2000 Elsevier Science B.V. All rights reserved.