Splanchnic organ injury during coronary surgery with or without cardiopulmonary bypass: A randomized, controlled trial
Splanchnic organ injury during coronary surgery with or without cardiopulmonary bypass: A randomized, controlled trial
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DOI：
10.1016/j.athoracsur.2005.06.038
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发表时间：
2006-01-01
影响因子：
4.6
通讯作者：
Angelini, GD
中科院分区：
文献类型：
--
作者：
Ascione, R;Talpahewa, S;Angelini, GD
背景。我们研究了冠状动脉手术合并或不合并体外循环对小肠、肝脏和胰腺功能的保护效果。患者随机分为非体外循环冠状动脉旁路移植术（OPCAB）和体外循环冠状动脉旁路移植术（CABG-CPB）两组。通过四种不同糖（O =甲基- d -葡萄糖、d -木糖、l-鼠李糖和乳果糖）的渗透性和吸收试验评估小肠功能。通过单乙基-电影苷/利多卡因比值和转氨酶（天冬氨酸转氨酶和丙氨酸-氨基转移酶）、胆红素和碱性磷酸酶的一系列测量来评估肝功能。通过胰岛素/胰高血糖素比值、淀粉酶和葡萄糖的一系列测量来评估胰腺功能。共招募40例患者（每组20例）。OPCAB组术后通透性和吸收率受损更严重，但两组术后第5天恢复到基线水平（手术类型和时间的相互作用，p = 0.05和p = 0.02）。单乙基甘氨酸乙酯/利多卡因比值在两组中无差异。CABG-CPB组的天冬氨酸转氨酶和丙氨酸-氨基转移酶水平在术后第一天较高，但在第3天趋于一致（手术类型和时间的相互作用，p < 0.0001和p = 0.04）。OPCAB组的胆红素水平在36小时超过CABG-CPB组，然后在术后60小时恢复到类似水平。CABG-CPB组淀粉酶水平高于OPCAB组（1.17倍，p = 0.03）；其他胰腺功能指标各组间无明显差异。OPCAB患者早期小肠功能较差；在第5天，两组的所有功能恢复到相似的水平。相反，CABG-CPB组的胰腺功能比OPCAB组差。肝代谢功能在手术结束前不会因手术类型而不同。CABG-CPB组术后肝细胞损伤更严重。
Background. We investigated the efficacy of coronary surgery with or without cardiopulmonary bypass in protecting the function of the small intestine, liver, and pancreas.Methods. Patients were randomized to off-pump coronary artery bypass grafting (OPCAB) or coronary artery bypass grafting with cardiopulmonary bypass (CABG-CPB). Small intestine function was assessed by differential four sugars (O = methyl-D-glucose, D-xylose, L-rhamnose, and lactulose) permeability and absorption tests. Liver function was assessed by monoethylgly-cinexylidide/lidocaine ratios and by serial measurements of transaminases (aspartate transaminase and alanine-amino transferase), bilirubin, and alkaline phosphatase. Pancreatic function was assessed by serial measurements of insulin/glucagon ratio, amylase, and glucose. Forty patients were recruited (20 per group).Results. Permeability and absorption were more impaired in the OPCAB group immediately after surgery, but returned to baseline levels in both groups by postoperative day 5 (interaction of surgery type and time; p = 0.05 and p = 0.02, respectively). Monoethylglycinexylidide/lidocaine ratios were not different in the two groups. Aspartate transaminase and alanine-amino transferase levels were higher in the CABG-CPB group for the first postoperative day, but levels converged by day 3 (interaction of surgery type and time; p < 0.0001 and p = 0.04, respectively). The bilirubin level for the OPCAB group overshot the CABG-CPB group at 36 hours before returning to a similar level 60 hours postoperatively. Amylase levels were higher in the CABG-CPB group than in the OPCAB group (1.17 times; p = 0.03); other markers of pancreatic function showed no differences between the groups.Conclusions. Early small intestine function is worse with OPCAB; all functions recover to similar levels in both groups by day 5. Conversely, pancreatic function is worse with the CABG-CPB group than with the OPCAB group. Hepatic metabolic function does not differ by type of surgery to the end of the operation. Postoperative hepatocellular injury was worse with the CABG-CPB group.