| The incidence of coronary atherosclerotic heart disease (coronary heart disease) is increased yearly with the improvement of the people's living standard and the change of diet. At present, conventional coronary artery bypass grafting (CCABG) is the main means to treat patients of coronary heart disease in the cardiothoracic surgery and has achieved satisfactory curative effect. However, the CCABG procedure is performed in the conditions of moderate systemic hypothermia, cardiopulmonary bypass, infusion of cold hyperkalemic cardioplegic solution and arresting heart, which may directly cause myocardial injury, myocardial hemorrhage and reperfusion injury and may also lead to the change of plasma concentrations of creatine kinase, creatine kinase-MB (CK-MB) and cardiac troponin I (cTnI). Cardiopulmonary bypass can induce the complement system activation and immune response, and affect perioperative production and secretion of proinflammatory cytokines such as interleukin-6 (IL-6), interleukin-8 (IL-8) and interleukin-10, which may contribute to the systemic inflammatory response and even severe multiple organ dysfunction after surgery. So the technique of off-pump coronaryartery bypass grafting (OPCAB) has been attached more and more importance. Compared with CCABG, OPCAB is performed in the conditions of normothermia and beating heart without cardiopulmonary bypass and infusion of cold hyperkalemic cardioplegic solution, which may be associated with reduced myocardial injury, less perioperative inflammatory response and fewer incidences of postoperative complications.In this prospective study, we compare the clinically curative effects and the production of perioperative plasma CK-MB, cTnl and cytokines in patients undergoing CABG with or without cardiopulmonary bypass in order to confirm the potential benefits of off-pump procedures.Materials and methods1, Subjects: Twenty-eight patients with coronary heart disease, diagnosed by coronary artery angiography and indicated for OPCAB and CCABG, were enrolled between January 2000 and December 2002 in this study. They were randomized into OPCAB group and CCABG group. There were no differences between the two groups of patients with respect to age, sex, body weight, symptoms or functional class.2, Anesthesia: All patients underwent trachea intubation and general anesthesia. Anesthesia was induced with midazolam and fentanyl, and was maintained by using intravenous propofol injection and isoflurance inhalation.3, Operative techniques: After successful anesthesia, the great saphenous veins were obtained. The surgery was through median sternotomy and one or two internal thoracic arteries were obtained. Patients in the OPCAB group underwent CABG in the conditions of normothermia and beating heart without cardiopulmonary bypass, while those in the CCABG group underwent CABG in the conditions of moderatesystemic hypothermia, standard cardiopulmonary bypass, infusion of cold hyperkalemic cardioplegjc solution and arresting heart.4, Measurement: In the clinical part, the surgery time, bleeding volume, blood transfusion volume, postoperative assisted respiratory time, intensive care unit stay, complications, mortality, hospitalization stay and hospitalization cost were studied. In the experimental part, blood samples were collected in 5ml from each patient before the operation, at the end of the procedure, and 2, 8, 24 and 48 hours after the operation. Samples were immediately centrifuged and plasma was stored. Levels of IL-6 and IL-8 were determined by means of enzyme-linked immunosorbent assays. Plasma levels of CK-MB were measured by an enzyme immunoassay. Cardiac troponin-I was measured using direct chemiluminometic technology.5, Medical Statistic Analysis: All data were statistically analyzed with SPSS/10.0 for Windows using a Compaq Pentium IH/1000. They were expressed as mean plus or minus standard deviation (x s). An analysis of variance, t test and chi-square test were used. A value of p less than 0.05 was considered statistically...
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