| ObjectiveCoronary artery bypass grafting (CABG) was the main surgery treats method about coronary artery disease (CAD), there has two methods:conventional coronary artery bypass grafting (CCABG) and off-pump coronary artery bypass grafting (OPCABG).They were to result in myocardial injury more and less, it was very important to evaluate myocardial injury at the earlier postoperative. Ischemia modified albumin (IMA) and Heart-type fatty acid binding protein (H-FABP) were the sensitive myocardial injury makers, had higher sensitivity and cardiac specificity.To investigate the change of perioperative release of cardiac troponin I (cTnI),IMA and H-FABP in patients undergoing OPCABG and CCABG, evaluating the difference of myocardial injury between OPCABG and CCABG. Discussed the reasons of myocardial injury in CABG.Contrasted cTnI, evaluated the relations between IMA,H-FABP level and myocardial injury and provided the experiment rationale.Methods40 consecutive patients were randomly assigned to CCABG group and OPCABG group,The concentrations of cTnI,IMA and H-FABP were measured in serial blood samples drawn before heparinization in both groups and after aortic unclamping at 0,3,6,12and 24 hours in the CCABG group. In the OPCABG group, samples were taken after the first distal anastomosis perfusion at the same time intervals as CCABG Group.Results:1 The increasing trend of cTnI were similar between OPCABG and CCABG, but elevated more obviously in the CCABG group, the parameters were statistically significant different between the two groups, compared with preoperative.In CCABG group, concentrations of cTnI were significantly higher. Beginning postoperative Oh and reached peak at postoperative 24h, the elevating extent was highest from postoperative Oh to 12h, in OPCABG group, concentrations of cTnI were significantly higher. Beginning postoperative 6h and reached peak at postoperative 24h, the elevating extent was highest from postoperative 6h to 24h.Demonstrated the myocardial injury of OPCABG were decreased significantly than CCABG 2 Concentrations of H-FABP of CCABG are higher obviously than the OPCABG. compared with preoperative, in CCABG group, concentrations of H-FABP were significantly higher beginning postoperative Oh and reached peak at postoperative 3-6 h group, drop at postoperative 12h and drop obviously at postoperative 24h, in OPCABG group, concentrations of H-FABP were significantly higher beginning postoperative Oh but the extent was lower than CCABG, and reached peak at postoperative 6-12h, drop at postoperative 24h.3 The trend of ACB were similar between OPCABG and CCABG, but decreased more obviously in the CCABG group, the parameters were statistically significant different between the two groups, compared with preoperative, in CCABG group, concentrations of ACB were significantly lowered, reached peak at postoperative 0-3h and retrieved at postoperative 6h. The trend of OPCABG was similar than CCABG but concentrations of ACB was higher than homologous time of CCABG.4 Multiple linearly dependence the H-FABP peak was connected with the amount of dopamine(r=0.452 P=0.004<0.05) and the ICU resident time (r=0.403 P=0.012<0.05); was non-connected With surgery time (r=0.300 P=0.067>0.05).The ACB lowest peak was non-connected With the amount of dopamine (r=-0.272 P=0.098>0.05) and the ICU resident time (r=-0.239 P=0.149>0.05).cTnI and H-FABP was connected (r=0.160 P=0.013<0.05), IMA and cTnI (r=-0.082 P= 0.206>0.05),H-FABP (r=-0.079 P= 0.224>0.05) was non-correlated.Conclusion:1 OPCABG disturbed slightly to organism physiology function than CCABG, the extend of myocardial injury is lower than the CCABG; CPB was the fundamental and primary factor of myocardial injury.2 H-FABP was a suitable myocardial injury maker, appraising the extend of myocardial injury was earlier and superior than cTnI.3 IMA diagnosis time window is narrow, the cardiac specificity is bad, does not diagnosis alone myocardial injury in the postoperative of CABG... |
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