| Objective:we compared the clinically curative effects and the production of perioperative plasma Endothelin-1,Brain natriuretic peptide and Cardiac troponinI in patients undergoing off-pump coronary artery bypass grafting(OPCAB) and on-pump coronary artery bypass grafting(on-pump CABG) in order to investigate the clinical effects of both the surgical treatments for coronary heart disease.Methods:From March 2008 to February 2010,a prospective,random, controlled trial was performed in 24 patients diagnosed coronary heart disease by coronary arteryangiography and indicated 14 patients for off-pump CABG(A group) and 10 patients for on-pump CABG(B group).A 2-ml sample of blood was obtained from the antecubital vein at the following time points:before surgery,immediately after operation and 6,24,72 hours,1 week after operation.Immediately placed in the chilled plastic tube with EDTA and aprotinin,at 4℃centrifugated for 10 minutes at 3000r/min in low temperature centrifuge after rocking gently,drawed the supernatant plasma,stored in the refrigerator at -70℃until the plasma was analyzed for ET-1 and BNP.At the same time we detected cTnI.Result:1.All patients were received operations sueeessfully and no case died after the operation.Compared with the on-pump CABG group,there were significantly less surgery time,drainage volume of pericardium and mediastinal and blood transfusion volume after operation,postoperative intensive care unit stay(P ＜0.01 ),and less assisted respiratory time,hospitalization stay,time and dosages of positive inotropic drugs in the OPCAB group(P＜0.05).One case of postoperative complication ocurred in the OPCAB group and four cases in the on-pump CABG group(P＞0.05).2.There were no statisic differences in ET-1 of the two groups before operation (P＞0.05).After the operation,Plasma ET-1 increased gradually and a peak concentration was observed in 6 hours after the operation in the two groups.Then plasma ET-1 decreased gradually and return to the baseline in 72 hours after the operation in the OPCAB group.While in the on-pump CABG group,plasma ET-1 levels still remained significantly high in 72 hours after the operation(P＜0.05) and return to the baseline in 1 week after the operation.ET-1 in immediately after operation and postoperative 6,24 hours were higher than that before the operation in both groups(P＜0.05).There were significantly higher ET-1 levels at the point of T2,T3,T4,T5 in the on-pump CABG group than in the OPCAB group(P＜0.05).3.Levels of plasma BNP showed no difference in both groups before the operation(P＞0.05).Six hours after the operation BNP increased gradually and postoperative 24 hours significantly increased.A peak concentration was observed in postoperative 72 hours in the two groups.Then plasma BNP decreased gradually but did not return to the baseline in 1 week after the operation.BNP in postoperative 24,72 hours,1 week were higher than that before the operation in both groups (P＜0.05).There were significantly higher BNP levels at the point of T4,T5,T6 in the on-pump CABG group than in the OPCAB group(P＜0.05).4.Levels of plasma cTnI showed no difference in both groups before the operation(P＞0.05).After the operation cTnI increased gradually and a peak concentration was observed in postoperative 6 hours in the two groups.Then plasma cTnI decreased gradually and return to the baseline in one week after the operation in the OPCAB group.While in the on-pump CABG group,plasma cTnI levels still remained significantly high in one week after the operation(P＜0.05).cTnI levels in immediately after operation and postoperative 6,24 hours,72 hours,1 week were higher than that before the operation in both groups(P＜0.05).There were significantly higher cTnI levels at the point of T2,T3,T4,T5,T6 in the on-pump CABG group than in the OPCAB group(P＜0.01). Conclusion:1.Compared with the on-pump CABG group,there were significantly less surgery time,drainage volume of pericardium and mediastinal and blood transfusion volume after operation,postoperative intensive care unit stay and less assisted respiratory time,hospitalization stay,time and dosages of positive inotropic drugs in the OPCAB group.2.Both the groups resulted in higher levels of ET-1 and BNP,but levels of ET-1 and BNP after on-pump CABG were higher than OPCAB.And perioperative myocardium injury in OPCAB group was significantly lower than in on-pump CABG group,heart function improved significantly.So OPCAB sugery showed more clinical and potential benefits than on-pump CABG for the treatment of coronary heart disease. |
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