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The Protection Effect of Creatine Phosphate during Off-Pump Coronary Artery Bypass Surgery

Author: ZhangBin
Tutor: ZhaoHong
School: Hebei Medical University
Course: Surgery
Keywords: creatine phosphate off-pump coronary artery bypass myocardial protection creatine kinase creatine kinase-MB cardiac troponin I interleukin-6 interleukin-8
CLC: R654.2
Type: Master's thesis
Year: 2008
Downloads: 111
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Abstract

Objective: Off-Pump Coronary Artery Bypass (OPCAB) Surgery avoid cardiopulmonary bypass (CPB), but myocardial injury can not total avoid. It is confirmed that creation phosphate protection effect on myocardial injury during open heart surgery with CPB, but there is no report about it during OPCAB procedure. This study was designed to observe the change of creation kinas (CK), creation kinas-MB (CK-MB), cardiac troponin I (cTNI), interleukin-6 (IL-6) and interleukin-8 (IL-8) during OPCAB surgery with or without creatine phosphate.Method:(1)40 patients who was diagnosed coronary artery disease with multi-vassals were divided into two groups in randomly. In experimental group: put 2g creatine phosphate into 250ml Ringer’s injection and patients began to transfusion with 200-250ml/h after intubated and before the start of surgery. In control group: patients transfused Ringer’s injection without creatine phosphate in same time and same speed with experimental group. (2)To draw vein blood preoperative, postoperative 6 hours, 12 hours,24 hours and 48 hours.(3)Put the blood specimens centrifugal with 3000rpm 5 minutes under 4℃circumstance after draw blood 2 hours and reserved the serum in -70℃refrigerator.(4)All patients were operated under general anesthesia with single-lumen intubated. All patients were punctured right radial artery and right jugular vein to monitor artery blood pressure and vein pressure. All patients were under median incision and sternotomy, harvested left internal mammary artery (LIMA) and radial artery (RA) or great saphenous vein (GSV) meantime. Towards the end of the harvest, systemic heparin was given intravenously at a dose of 1mg/kg.Then cut pericardium and hanged up it after LIMA took down. We used Guidant stabilizer to fix the target vessel and put the shunt in the coronary artery after incised the distal of it, then anastomased in an end-to-side with 7-0 Prolene according as continue suture .The sequence of anastomases according to left anterior descending(LAD) artery first, right coronary artery(RCA)and left circumflex(LCX) artery in turn. The proximal coronary anastomases were performed during a period of side clamping of the ascending aorta and anastomased with 6-0 Prolene in an end-to-side according as continue suture after punctured on ascending aorta. The ventricular arrhythmia incident and low output syndrome were observed after the surgery. CK, CK-MB, cTNI, IL-6, IL-8 were analyzed centered in the end. The measurement data were indicated as means±standard ( x±s). Group comparisons were made using unpaired t test, and chi-square or Fisher exact test for dichotomous parameters. A P value of less than 0.05 was taken to indicate significance.Result:(1)The basic conditions of patients: There were 20 patients in experimental group including male 15 and female 5, and 7 patients complicated diabetes mellitus ,12 patients complicated hypertension,4 patients complicated left main coronary artery stenosis>50%, the mean age±SD was 60.7±2.0 and the mean ejection fraction±SD was 59.4±1.9.There were 20 patients in control group including male 14 and female 6, and 5 patients complicated diabetes mellitus , 14 patients complicated hypertension,4 patients complicated left main coronary artery stenosis>50%, the mean age±SD was 57.1±1.9 and the mean ejection fraction±SD was 56.8±2.1.The baseline characteristics were no difference between two groups (P>0.05).(2)Results of operation: In total 63 grafts were completed in experimental group, including 18 left internal mammary artery grafts,4 radial artery grafts and 41 great saphenous grafts, the sum of distal anastomasis was 71, the mean grafts±was 3.15±1.09 and the mean distal anastomasis±was 3.55±0.14. In total 59 grafts were completed in control group, including 18 left internal mammary artery grafts,2 radial artery grafts and 39 great saphenous grafts, the sum of distal anastomasis was 63, the mean grafts±was 2.95±0.60 and the mean distal anastomasis±was 3.15±0.17.There was no difference between two groups(P>0.05).(3)The result of CK: The serum levels of CK were no difference between two groups preoperative(P>0.05).The CK serum levels of experimental group were lower than control group in 6 hours, 12 hours and 24 hours after the end of surgery(P<0.001).There was no difference between two groups in 48 hours after the end of surgery(P>0.05).(4)The result of CK-MB: There were no difference of the serum levels of CK-MB between two groups before the start of surgery. The CK-MB serum levels of experimental group were lower than control group in 6 hours, 12 hours and 24 hours after the end of surgery (P<0.001).No difference between two groups in 48 hours after the end of surgery (P>0.05). (5) The result of cTNI: There were no difference of the serum levels of cTNI between two groups before the start of surgery (P>0.05). The serum levels of cTNI of experimental group were lower than control group in 6 hours, 12 hours, 24 hours and 48 hours after the end of surgery (P<0.001). (6) The result of IL-6: No difference between two groups before the start of surgery (P>0.05).A significant decrease in the serum levels of IL-6 in experimental group 6 hours after of the end of surgery when compared with control group(P<0.001). There were no difference of the serum levels of IL-6 between two groups 12 hours, 24 hours and 48 hours after the end of surgery(P>0.10).(7) The result of IL-8: There were no difference of the serum levels of IL-8 between two groups preoperative. A significant decrease in the serum levels of IL-8 in experimental group 6 hours, 12 hours and 24 hours after of the end of surgery when compared with control group and the P value was <0.05, <0.01, <0.01, respectively. No difference between two groups in 48 hours after the end of surgery. (8) The results of ventricular arrhythmia and low output syndrome: In experimental group, one patient was diagnosed ventricular arrhythmia after surgery; no one diagnosed low output syndrome and no one dead. In control group, 6 patients were diagnosed ventricular arrhythmia after surgery, 2 patients were diagnosed low output syndrome and no one dead. No patients converted into cardiopulmonary bypass procedure. The morbidity of ventricular arrhythmia was no difference between two groups (P>0.05). The morbidity of low output syndrome was no difference between two groups (P>0.05).Conclusion:(1)CP may decrease the release of CK and CK-MB during OPCAB. (2)CP may decrease the release of cTNI during OPCAB. (3)CP may decrease the release of IL-6 and IL-8 during OPCAB.

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