The study of neurohormonal factors during the perioperative period of coronary artery disease / 中华胸心血管外科杂志

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.