| OBJECTIVE:To investigate the change of perioperative plamsa arginine vasopressin (AVP)concentration during on-pump coronary artery bypass grafting (CABG), and its effects on hemodynamics and postoperative outcomes.METHODS:Forty patients under gonging elective on-pump CABG were randomly enrolled in this study. Blood samples were collected to determine the plasma AVP concentration at the following points:before induction of anesthesia (T1), before skin incision (T2), onset of cardiopulmonary bypass (CPB) (T3), rewarming (T4), end of CPB (T5), end of operation (T6) and 24h after the operation (T7). The hemodynamics variables were monitored both before skin incision and 10 min after end of CPB. Perioperative clinical information was collected.RESULTS:The concentration of perioperative plasma AVP in patients undergoning on-pump CABG demonstrated different levels. Forty patients were divided into the high-level group (n=22) and the low level group (n=18) by hierarchical clustering analysis, according to their perioperative plasma AVP concentration. Compared to the high-level group, patients in the low-level group more often occur vasoplegia accompanied with high cardiac output (38.9% vs.0, P<0.01) and lower mean arterial pressure (69±6 vs.75±6, P<0.01) at 10 min after end of CPB, more common use of vasoconstrictive drugs (83.3% vs.36.4%, P<0.01). The duration of CPB (140±38 vs.80±17, P<0.01), mechanical ventilation(22±2 vs.19±2, P<0.01), ICU stay (4±4 vs.1±0, P<0.05) and postoperative hospital stay (10±7 vs.7±0, P<0.05) were longer than high-level group. The low-level group appeared different from the high-level groups in terms of myocardial infarction history (83.3%vs.9.1%, P<0.01), preoperative left ventricular ejection fraction (LVEF) (51±8% vs.61±7%, P<0.01) and preoperative use ofβ-blockers (100% vs.72.7%,P<0.05). However, only myocardial infarction history (OR=0.020, P<0.01) and preoperative LVEF (OR=1.210, P<0.01) were significantly correlated with the low-level group.CONCLUSION:The concentration of perioperative plasma AVP in patients undergoning on-pump CABG demonstrated two distinct trends of change. Both myocardial infarction history and low preoperative LVEF are potential risk factors for low-level plasma AVP. Patients with Low-level plasma AVP had worse hemodynamics and poor postoperative outcomes. |
