【摘要】 目的检测具有高危因素的行冠状动脉旁路移植术(CABG)病人的相关神经体液因子,结合临床改变,寻找针对性的处理措施及依据,减少并发症。方法48例病人分A组23例行体外循环冠状动脉旁路移植术(CCABG);B组25例行非体外循环冠状动脉旁路移植术(OPCAB)。围术期分6个时间点测定血浆中血管紧张素II(AGII)、醛固酮(ALD)、心钠素(ANP)、胰岛素(INS)、血糖(SUG)和肌钙蛋白I(cTnI)。结果血浆AGⅡ水平,A组术后6h、B组术后3h达高峰。血浆ALD水平,A组术后6h、B组在术后0h达高峰。血浆ANP水平,A组术后0h、B组术中已达高峰。血浆胰岛素水平,A组术后24h、B组术后6h达高峰,术后24hA组显著高于B组。血糖水平,A组术后3h、B组术后0h达高峰。血浆AGII、ALD、ANP和血糖水平术中及以后各时点A组均显著高于B组。血浆cTnI水平,术后3~24hA组显著高于B组。结论CABG均可出现血糖升高的高渗性利尿和高醛固酮血症的利尿,CCABG组是二者同时升高出现强而持久的利尿,OPCAB组则以高渗性利尿为主,持续时间短。CABG,尤其CCABG应使用血管紧张素转换酶抑制剂(ACEI)、AGII受体拮抗剂(ARB)和抗醛固酮制剂;术后6h内更应降血糖,补充钾、镁制剂。更多还原

【Abstract】 Objective To study the change of neurohormonal factors during CABG and find the effective perioperative treatments for coronary artery disease patients with high-risks. Methods Forty-eight patients were divided into on-pump CABG group(group A, n=23) and off-pump CABG group(group B, n=25). The clinical results were observed and blood samples were collected at six time-points. Angiotensin II(AG II), aldosterone(ALD), atrial natriuretic peptide (ANP), insulin, glucose and cTnI levels in plasma were measured respectively. Results The AG II levels in plasma increased in both groups and reached the peak at 6 h after operation in group A and 3 h after operation in group B, respectively. The peak level of ALD in plasma were at 6 h in group A, and 0 h in group B. The level of ANP in plasma was highest at 0 h in group A, and at the midoperation in group B. The insulin level in plasma was highest at 24 h in group A and at 6 h in group B. The insulin level at 24 h in group A was significantly higher than that in group B. The glucose level reached the peak at 3 h after operation in group A and at 0 h after operation in group B. The levels of AG II, ALD, ANP and glucose in plasma in group A were significantly higher than those in group B at any time-point. The cTnI levels were highest at 24 h in both groups. The cTnI levels in group A were significantly higher than group B at time-points. Conclusion CABG can produce hyperosmotic urinative effects and hyperaldosteronism, which in CABG group is strong and persistent effects due to the hyperosmotic urinative effects and hyperaldosteronism. In OPCAB group is light and short urinative effects mainly due to the hyperosmotic. ACEI, ARB and aldosterone antagonists should be used during the perioperation of CABG. During the early postoperative period, the plasma glucose should be well controlled and GIK solution with magnesium is needed.更多还原