Inflammatory response and changes in pulmonary function after myocardial revascularization with or without cardiopulmonaryt bypass / 中华麻醉学杂志

ABSTRACT

Objective To compare the degree of inflammatory response and changes in pulmonary function in patients undergoing coronary artery bypass grafting (CABG) with or without cardiopulmonary bypass (CPB) Methods Elective CABG was performed in twenty-two patients with CPB (n = 11) or off-pump (n = 11). The patients were premedicated with oral midazolam 7.5 mg and intramuscular morphine 10 mg. Anesthesia was induced with fentanyl 5-10 ?g?kg-1 , midazolam 0.05 mg?kg-1 , etomidate 0.15 mg?kg-1 and rocuronium 0.6 mg?kg-1 and maintained with intermittent i.v. boluses of fentanyl and rocuronium. All patients had pulmonary artery catheter and arterial line placed. ECG, SpO2, PET CO2 , body temperature and urine output were monitored. In CPB group aprotinin was given. The patients were transferred to ICU after operation and mechanically ventilated. Extubation was performed when standard extubation criteria were met. The length of ICU stay and hospitalization were recorded. CI, PVRI, SVRI, PA-aO2 , PaO2/FiO2 and QS/QT were measured and calculated before and at the end of operation and 4, 12, 24, 36 h after operation. Blood samples were taken from radial artery and pulmonary artery (mixed venous blood) before and at the end of operation and 4, 12, 36 h after operation for determination of plasma levels of IL-6, IL-8 and neutrophil elastance, the numbers of WBC and neutrophil, the numbers of WBC and neutrophil segregated in the lungs (the number of WBC/neutrophil in mixed venous blood - the number of WBC/neutrophil in arterial blood) .Results The two groups were comparable with respect to age, sex, duration of anesthesia and surgery and the number of grafts. CI was significantly increased while SVRI significantly decreased after operation as compared to the baseline values before operation. There was no significant difference in CI and SVRI after operation between the two groups. The postoperative PVRI and PA-a O2 were significantly lower while postoperative PaO2/FiO2 was significantly higher in the off-pump group than in the CPB group ( P