The Prognostic Analysis Of Choosing The Grafts And The Level Of GPBB In Patients With Coronary Artery Bypass Grafting

Backgroud:Coronary Heart Diseases(CHD) is a kind of diseases caused by coronary atherosclerotic with coronary artery stenosis or occlusion in patients with myocardial ischemia and hypoxia, which is seriously harmful for patients’ health and life. The process of being coronary atherosclerosis is always slow and with multi-factors, via the following possible mechanisms: liqid deposition under the artery intimal, the formation of atherosclerotic plaques, changes in convexing to the lumen, then thrombosis, vascular stenosis, and vascular obstruction. With the improvement of people’s living standard in our country in recent years, diet adjustment, the number of obese people has increased dramatically in our country, due to the young smokers increased at the same time, the onset of coronary heart disease(CHD) crowd gradually tend to be younger, coronary heart disease onset nasty, progress is fast, has serious damage to human body health and life safety. Has serious damage to people’s life safety in our country.The common recognized treatment of coronary heart disease is Percutaneous Coronary Intervention(PCI) and early unstable angina patients have good curative effect with this method. But PCI remains limited, can’t solve the problem of all lesions in Coronary heart disease(CHD) patients with smooth, therefore, Coronary Artery Bypass Grafting(CABG) has become one of the most effective surgical method for the treatment of Coronary heart disease(CHD). CABG is the obstruction of the coronary artery replaced with new unblocked blood vessels, to improve myocardial ischemia and cure angina pectoris. The main method of CABG is the selection of new blood vessels such as internal mammary artery, radial artery, great saphenous vein and other artery or venous grafts, and the establishment of new vascular access between the pathological vessels of obstruction to the ascending aorta root distal, making the blood from the left ventricle pumps out after a new frame by aortic vascular bridge, flowing to the distal vascular lesion, bypassing the coronary artery lesions obstruction, then offering new blood supply of myocardium. CABG properly solve the problem of the pathological changes of myocardial blood flow, but the ischemia reperfusion injury is difficult to avoid, how to early detection and diagnosis of CABG myocardial damage, early treatment, is a problem to be solved. Therefore, how to select bridge blood vessels, and to find a judge CABG myocardial damage markers, initial solution, to reduce myocardial damage as far as possible, to improve the therapeutic effect of CABG, is now a major focus in the study.Based on the analysis of coronary heart disease and coronary artery bypass grafting in the change of various factors, we found a phenomenon, recently, a study shows that not only the morbidity of coronary heart disease increased year by year, the morbidity of coronary heart disease(CHD) with sugar metabolic abnormalities was also increased year by year, research of the relationship between coronary artery disease and sugar metabolism has become a hot research topic today. Sugar metabolic abnormalities can affect the occurrence and development of coronary heart disease, may be associated with the both share pathogenesis. Heart operation need the body’s ability to provide a lot of, as one of three big energy glucose metabolism is undoubtedly important role in the process of cardiac pathological physiology, sugar metabolic abnormalities can further promote the occurrence and development of coronary heart disease may be related to both cross(Crosstalk) has a complex signal transduction of pathogenesis related. Coronary artery sex heart disease patients are often accompanied by complications such as diabetes and high cholesterol, and lead to disease treatment is particularly complex, judge vitreoretinal surgery and to evaluate the effect of the operation is extremely difficult. Therefore, the research of sugar metabolism abnormity and intraoperative and postoperative prognosis with coronary artery disease in coronary artery bypass grafting is necessary.Glycogen phosphorylase isoenzyme BB(GPBB) is a new evaluation index of myocardial ischemia anoxic injury, has been used to early diagnose myocardial angina and acutemyocardialinfarction(AMI). Glycogen phosphorylase(GP) is a key rate-limiting enzyme of glycolysis metabolism, playing a key role in the glycogen decomposition and the regulation of glucose metabolism. When serious ischemia myocardial hypoxia, glucose content reduces quickly and failing to timely supplement, glycogen decomposition increases, glycogen phosphorylase tansforms from inactive GPb into active GPa, broken down into glucose-1-phosphoric acid. In the process of Glycogen decomposition, the transformation of glycogen phosphorylase from glycogen, free of glycogen phosphorylase in intracytoplasmic concentration increased significantly, when myocardial cells are in ischemia anoxic condition, permeability of cell membrane increase, glycogen phosphorylase isoenzyme BB are released into the peripheral blood, therefore, can be detected in the early myocardial injury. At present, the glycogen phosphorylase isoenzyme BB(GPBB) is a judgment for coronary artery bypass grafting in patients with poor prognosis of markers has not been reported, therefore, this research mainly through the determination of serum level of GPBB, analyze its relationship with coronary artery bypass grafting and myocardial injury, is expected to make early judgment for myocardial damage of coronary artery bypass grafting.Objective:Through the detection of CABG patients with intraoperative and postoperative clinical indicators of change, to analysis the effect of immediate and long-term after surgery of total artery bridge and total vein bridge. In order to better analyze the influence factors of CABG, using subgroup analysis for the total artery bridge group and the whole set of two groups of patients with venous bridge, for clinical provide theoretical basis for choosing the appropriate grafts materials. Detection the level change of serum Glycogen phosphorylase isoenzyme(Glycogen phosphorylase isoenzyme BB, GPBB) in intraoperative and postoperative coronary artery bypass grafting, exploration the relations with GPBB and myocardial injury, and the role of GPBB in early judgment of postoperative outcomes with CABG.Methods:All 80 cases with suspected coronary artery disease were collected from October in 2012 to October in 2014 in our hospital, the diagnosis of coronary atherosclerotic heart disease were detected by coronary angiography and be sure to conduct coronary artery bypass grafting. Forty-one cases were adopted by full arterial grafts with the whole artery bridge group and thirty-nine cases were adopted by full vein grafts in whole vein bridge group. Cooperation on the selected data analysis, evaluation whether the long-term outcomes in patients of the two grafts is affected by the influence of patient characteristics.Two groups of patients are used in the middle of open heart operation, choose internal mammary artery(IMA), or greater saphenous vein as grafts materials. Evaluation, the evaluation index of all patients underwent surgery including average operation time, aorta blocking time and auxiliary time of postoperative respiratory machine, chest drainage fluid volume, length of hospital stay after the surgery, and grafts patency rate and so on, compare all indexes of all artery bridge group and all venous bridge to discuss the relationship with prognosis of surgery. All patients or patients’ families were agreed, so collect artery blood sample at ascending aorta block immediately, 30 min after opening the ascending aorta, 2 h after the ascending aorta open, 4 h after opening the ascending aorta, 24 hours after operation, 48 hours after operation, using ELISA method to detect the serum level of glycogen phosphorylase isoenzyme(GPBB). Analysis the relationship with GPBB and the prognosis of patients with coronary artery bypass grafting, and the difference between the two groups of all artery bridge group and full vein bridge group. Meanwhile, subgroup analysis the factors for the patient, such as gender, age, smoking history, history of hypertension, diabetes history, history of cerebrovascular accident, past CABG, preoperative atrial fibrillation and left main lesion, three pathological changes such as the choice of blood vessels and coronary artery bypass grafting bridge.Using SPSS 17.0 statistical software for statistical analysis of data, all measurement data with( x ±s), is compared between group by t test and variance analysis; Count data by chi-square test. With P<0.05 showed statistically significant difference.Results:1.Comparing the clinical effects of total artery bridge group and all vein bridge group of patients with postoperative. In the 80 patients after coronary artery bypass graft, 3 cases with hospital death, which 1 cases of death in total arterial bridge group, and 2 patients died in the entire vein bridge group, there is no statistically significant difference between the two groups(P>0.05). Compared with the two groups after operation, there are average statistical significance of operation time, aortic cross clamp time, mechanical ventilation time after operation, postoperative atrial fibrillation(P<0.05), in which the situation of postoperative mechanical ventilation time, postoperative atrial fibrillation in the whole arterial bridge group were superior to than of full vein bridge group(P<0.05); the average operation time, aortic cross clamping time in full vein bridge group is better than the whole arterial bridge group(P<0.05). There were no statistical significance difference in thoracic drainage fluid volume, hospital time after operation, incision infection, renal insufficiency, cerebrovascular complications, pulmonary complications, cardiac arrest or ventricular fibrillation(P>0.05).2. Comparison the rate of graft patency between total artery bridge group and total intravenous bridge group. A total of 80 patients were transplanted 204 vessels, the average is 2.55. There is 86 cases in the whole arterial bridge using internal mammary artery(LIMA); there is 118 cases in total intravenous bridge using saphenous vein(SV). Patients were followed up 2 week, 1 month, 3 months after operation, rate of patients graft patency in total artery bridge group were 95.3%, 93.0%, 89.5%; rate of patients graft patency in total intravenous bridge group were 94.1%, 78.0%, 71.2%. The results showed, the patency rate of total arterial bridge group was better than full vein bridge group, with statistically significant difference(P<0.05).3. Subgroup analysis of effects of the rate of grafts vessels between total arterial bridge group and total vein bridge group. Further subgroup analysis of the relationship between the rate of the long-term patency of 3 months and indexes of two groups in patients with postoperative, the results displayed, there were statistical significance of age、body mass index、smoking、hypertension、diabetes、high blood lipids、with previous history of myocardial infarction between total artery bridge groups and vein bridge groups(P<0.05). There were not statistically significant in gender、history of cerebrovascular accident、had historic CABG or PCI lesions、two arteries、three arteries lesion、left main coronary artery lesions in total arterial bridge group and full vein bridge group(P>0.05). Therefore, it is necessary to analyze the miltiterm reference rather than simply according to an index in the choice of coronary artery bypass grafts.4. The level of GPBB in operation and postoperation between total artery bridge group and total venous bridge. The results showed, the concentration of GPBB were increased during coronary artery bypass graft surgery and after myocardial injury, and was positively correlated with the degree of myocardial injury, aortic cross clamp time. GPBB could be detected after opening aorta in CPB, can be achieved peak after aortic opening aorta 30 min(T1), decreased gradually after opening aorta 2 h(T2), gradually restored to the level before aortic cross clamping after opening aorta 24 h(T4). Therefore, GPBB can be used for the early evaluation of myocardial injury degree in patients with coronary artery bypass grafting, with high sensitivity, and GPBB rises peak quickly, recover fast.5. The comparion of the level of GPBB in operative and postoperative between total artery bridge group and all venous bridge groups. The results showed, the serum level of GPBB in two groups was not much difference before aortic cross clamping, GPBB changed obviously after coronary artery bypass grafting, especially in 30 min after opening aorta, rises quickly to a peak, and block level to fall back after 24 h. Comparison the GPBB of two groups of patients, there were statistically significant in T1, T2 time point, that is after the ascending aorta open 30 min, after aorta opening 2 h, P<0.05; and the level of GPBB in full vein bridge group was lower than that in total arterial bridge group, which reminder the damage myocardial caused on patients in whole arterial bridge was smaller than all vein bridge.Conclusions:1. The whole line bridge group of coronary artery bypass grafting surgery has good curative effect, less adverse reaction, less serious complications.2. Younger than 65 years, and with a history of smoking and high blood pressure patients, all choose grafts in the prognosis of patients with artery bridge is superior to choose all patients with venous bridge; Body mass index(BMI) of patients with greater than 25 kg/m2, with a history of diabetes or a history of sugar metabolic abnormalities in patients with coronary heart disease, high cholesterol, and with a history of myocardial infarction patients, all choose grafts in the prognosis of patients with venous bridge is superior to choose all the artery bridge;3. GPBB can early predict patency rate and prognosis of coronary artery bypass grafting patients. The application of GPBB as a marker to diagnosis of early myocardial infarction can evaluate the prognosis of patients with coronary artery bypass grafting.