| Objective:This study was to explore the difference of perioperative insulin resistance and inflammatory reaction by comparing on the perioperative assessment of insulin resistance and inflammatory cytokines between conventional coronary artery bypass grafting and off-pump coronary artery bypass grafting,it is necessary to tight perioperative glycemic control with advisable using insulin and to reduce postoperative adverse outcomes.Methods:This was a randomized control design.Forty patients scheduled for coronary artery bypass grafting were divided randomly into two groups:the CPB group(group CCABG,n=20)and offpump group(group OPCAB,n=20).Specimens of plasma were collected irrespectively at five time points:before induction of anesthesia(T1),aftcr internal mammary artery harvested(T4),after proximal anastomoses(T3),at the end of operation(T4),24h after the end of operation(T5),the specimens were taken for the measurements of concentrations of blood glucose, insulin and cytokines,the assessment of insulin resistance was calculated with homeostasis model assessment of insulin resistance(HOMA-IR).Then the preoperative changes of insulin resistance and inflammatory were compared between two groups.The clinical factors were compared between the two groups,statistics treatment:The measurement data was expressed as "(?)±s".The measurement count was expressed "χ~2",and using Indepentdent-Samples T Test program and Repeated Measures ANOVA program of SPSS13.0 software to analyze it.When the value of "P" is lower than 0.05,it has statistical significance.Results:No death or major complications as perioperative myocardial infarction and infection were found in the study.1.General Clinical Information There were no significant differences of the gender,the age and the body mass between CCABG and OPCAB groups(P＞0.05). but compared with the CCABG group,the duration of operation,the length of stay in ICU and the time of tracheal intubation decreased respectively in the OPCAB group. the differences OPCAB groups(P＞0.05),but compared with the CCABG group,the duration of operation,the length of stay in ICU and the time of tracheal intubation decreased respectively in the OPCAB group,the differences between the two groups were statistically significant(P＜0.05).comprised of 35 males(76.1%).The gender showed no significant difference between the two groups(P＞0.05).2.Glucose The glucose concentrations changed with the time factor and showed significant difference between the two groups(P＜0.05).Compared between the two groups,there were no statistically significant defference of blood glucose concentration at T1(P＞0.05).The concentration of blood glucose at T2,T3,T4 and T5 were significantly lower in the OPCAB group than the CCABG group(P＜0.05).The glucose concentration had significant difference at the five time points in each group(P＜0.05).The level of glucose at T2,T3,T4 and T5 was higher than at T1 in the CCABG group,and T3 was the highest(P＜0.05).In the OPCAB group,there were no significant difference between T2 and T5,T3 and T4(P＞0.05),but they were all higher than T1,and the value of T3 and T4 was higher than that of T2 and T5(P＜0.05).3.HOMA-IR HOMA-IR changed with the time factor and showed significant difference between the both groups(P＜0.05).Compared between the two groups, HOMA-IR had no statistically significant difference at T1 and T2(P＜0.05).At other time points,HOMA-IR was significantly lower in the OPCAB group than that in the CCABG group(P＜0.05).Compared within the each group,the level of HOMA-IR had significant difference at the five points(P＜0.05),it was the highest at T4 in the CCABG group and was the lowest at T1 in that group.In the OPCAB group,the level of HOMA-IR was the lowest at T1 and changed into the highest at T4(P＜0.05).4.IL-6 The value of IL-6 changed with the time factor and showed significant difference between two groups(P＜0.05).There were no significant differences of IL-6 value at T1 and T2 in the CCABG group compared to OPCAB at the same time,but the value showed significant difference at T3,T4 and T5 between the two groups (P＜0.05).The levels of IL-6 were higher at T3,T4 and T5 in the CCABG than that in the OPCAB.Compared within the each group,,the value of IL-6 showed significant difference at the five points(P＜0.05),it was the highest at T4 in the CCABG group and was the lowest at T1 in that group.In the OPCAB group,the level of HOMA-IR was the lowest at T1 and changed into the highest at T4(P＜0.05).5.IL-10 The concentrations of IL-10 changed with the time factor and showed significant difference between two groups(P＜0.05).There were no significant differences of IL-6 concentration at T1 and T2 in the CCABG group compared to OPCAB at the same time,but the concentration showed significant difference at T3,T4 and T5 between the two groups(P＜0.05).The levels of IL-10 were higher at T3,T4 and T5 in the CCABG than that in the OPCAB.Compared within the each group,.the levels of IL-10 showed significant difference at the five points(P＜0.05), the level of IL-10 was the highest at T3 in the CCABG group and was the lowest at T1 in that group.In the OPCAB group,the level of IL-10 was the lowest at T1 and changed into the highest at T3(P＜0.05).Conclusions:1.The inflammatory response and insulin resistance were found perioperatively in coronary artery bypass grafting with or without cardiopulmonary bypass.2..The HOMA-IR and inflammation cytokine show dynamic change in coronary artery bypass gratfing during perioperation.3.CPB might be a major faetor of insulin resistance and inflammatory response after conventional coronary artery bypass grafting.4.Compared with CCABG,OPCAB is associated with reduced cytokine release and less insulin resistance,meanwhile,it shows better benefit both on the economy and on the society,such as the patients can recover quickly and the cost of hospitalization is not higher.
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