Effects Of Pericardial Shed Blood Re-transfusion During Off-pump CABG On Inflammatory Reaction, Myocardial Injury And Lung Function

Back ground and Objective:When the body is hitted by infectious or non-infectious factors,such as operation,trauma,hypoxia and re-perfusion injury,various inflammatory media will be released within the body,and inflammatory reaction occurs.Pro- and anti-inflammatory cytokines are the main inflammatory media. Imbalance of pro-and anti-inflammation will induce systemic inflammatory reaction syndrome(SIRS)which is self-injury.These inflammatory media can further cause more severe secondary insult by means of direct injury of cell membrane,effect of cell matabolism and changes of whole body vascular permeability.And a constantly self enhanced vicious cycle will be formed,which can cause severe injury to tissues and organs and result in multiple organ dysfunction syndrome(MODS)at last. During heart operaton,inflammatory cytokines can be excessively generated and released within the body because of trauma,especially cardiopulmonary bypass(CPB), which can induce self injury SIRS and result in MODS.Its excessive reaction is asssociated with notable hemodynamic changes during the operation,myocardial injury and severe complications post operation.The destroy and recovery of the pro- and anti-inflammatory reaction balance determine the clinical appearance and results of perioperation.During OPCAB,re-transfusion of pericardial shed blood and CPB have similar process although CPB is avoided.This research aimed to investigate the effects of pericardial shed blood re-transfusion during off-pump CABG on inflammatory reaction,myocardial injury and lung function.Methods:44 patients for first time elective CABG were selected and divided into three groups.Control Group:13 patients with on-pump CABG.OPCAB1 Group:16 patients with off-pump CABG,amount of pericardial shed blood re-transfusion over 600 ml.OPCAB2 Group:15 patients with off-pump CABG,amount of pericardial shed blood re-transfusion less than 600 ml.Plasma samples from vein were collected for measurement of IL-6,IL-8,IL-10 and TNF-αafter anesthesia induction and 1,4, 24,72 hours post-operation respectively,and tested by liquidchip.Perioperative leukocyte,platelet,CK-MB,TnI,AaDO₂ and PaO₂/FiO₂ were recorded. Results:All are not significantly differenct in terms of gender,age,bodyweight, history of hypertension,cardiac infarction and diabetes,LVEF and LVED of pre-operation,and amount of bypass graft.At the time of 1 hour post-operation,levels of IL-6 and IL-8 in OPCAB1 group were higher than those in OPCAB2 group (P＜0.05)and about the same as those in CABG group(P＞0.05).4 hours after the operation,the level of platelet in CABG group was lower than that in OPCABG1 group and OPCABG2 group(P＜0.05),but there was no significant difference between OPCABG1 group and OPCABG2 group(P＞0.05).There was no significant difference on the level of leukocyte among three groups.Four hours after the operation,level of CK-MB in OPCAB1 group was lower than in CABG group (P＜0.05)and similar in OPCAB2 group(P＞0.05).4 and 24 hours after the operation, the levels of TnI in OPCABG1 group were lower than those in CABG group (P＜0.05)and about the same as those in OPCABG2 group(P＞0.05).There was no significant difference on AaDO₂ and PaO₂/FiO₂ among three groups,Conclusion:The present results showed that re-transfusion of pericardial shed blood during OPCAB enhance plasma levels of cytokins,but it did not cause changes of the amount of platelet and leukocyte,did not cause myocardial injury and affect the gas exchange function of lung significantly.Myocardial injury in OPCAB was less than that in CABG,and had no correlation with inflammatory reaction.