Reduction of the inflammatory response in patients undergoing minimally invasive coronary artery bypass grafting
Reduction of the inflammatory response in patients undergoing minimally invasive coronary artery bypass grafting
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DOI：
10.1016/s0003-4975(97)01127-2
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发表时间：
1998-02-01
影响因子：
4.6
通讯作者：
Boonstra, PW
中科院分区：
文献类型：
--
作者：
Gu, YJ;Mariani, MA;Boonstra, PW
背景这项前瞻性研究的目的是确定在接受微创冠状动脉旁路移植术的患者中，炎症相关的临床发病率以及炎症反应的亚临床标志物是否减少。1995年6月至1996年6月，62例孤立性冠状动脉左前降支狭窄患者随机分为两组：31例行微创冠状动脉旁路移植术，31例行常规冠状动脉旁路移植术。在每组10名患者的亚组中，测量亚临床标志物以确定手术期间产生的炎症反应水平。在接受微创冠状动脉旁路移植术的组中，白细胞弹性蛋白酶、血小板β-血栓球蛋白和补体C3 a在手术结束时与其基线浓度相比没有变化，而在接受常规冠状动脉旁路移植术和体外循环的组中，这些炎症标志物显著增加。微创冠状动脉旁路移植术的患者手术时间较短（104 +/- 28 vs 140 +/- 28分钟; p < 0.01），失血量更少（312 +/- 167 vs 788 +/- 365 mL; p < 0.01），较短的排便支持（7.7 +/- 4.1 vs 12.9 +/- 3.4小时; p < 0.01），术后住院时间更短（4.4 ± 1.7 vs 7.7 ± 2.6天; p < 0.01）。结论这些数据表明，接受微创冠状动脉旁路移植术的患者与接受常规冠状动脉旁路移植术和体外循环的患者相比，全身炎症反应、术后发病率和住院时间显著减少。
Background. The aim of this prospective study was to determine whether the inflammation-associated clinical morbidity as well as the subclinical markers of the inflammatory response are reduced in patients who undergo minimally invasive coronary artery bypass grafting without cardiopulmonary bypass.Methods. From June 1995 to June 1996, 62 consecutive patients with isolated stenosis of the left anterior descending coronary artery were assigned randomly to two groups: 31 patients underwent minimally invasive coronary artery bypass grafting and 31 patients underwent conventional coronary artery bypass grafting with cardiopulmonary bypass. In a subgroup of 10 patients in each group, subclinical markers were measured to determine the level of the inflammatory response generated during the operation.Results. In the group that underwent minimally invasive coronary artery bypass grafting, leukocyte elastase, platelet beta-thromboglobulin, and complement C3a were unchanged at the end of the procedure compared with their baseline concentrations, whereas these inflammatory markers were increased significantly in the group that underwent conventional coronary artery bypass grafting with cardiopulmonary bypass. The patients who underwent minimally invasive coronary artery bypass grafting had a shorter duration of operation (104 +/- 28 versus 140 +/- 28 minutes; p < 0.01), less blood loss (312 +/- 167 versus 788 +/- 365 mL; p < 0.01), shorter ventilatory support (7.7 +/- 4.1 versus 12.9 +/- 3.4 hours; p < 0.01), and a shorter postoperative hospital stay (4.4 +/- 1.7 versus 7.7 +/- 2.6 days; p < 0.01) than the patients who underwent the conventional procedure.Conclusions. These data suggest that patients who undergo minimally invasive coronary artery bypass grafting have a significant reduction in the systemic inflammatory response, postoperative morbidity, and hospital stay compared with patients who undergo conventional coronary artery bypass grafting with cardiopulmonary bypass.