The Change Of Inflammatory Factors On CABG Supported By Extracorporeal Membrane Oxygenation

Objective To investigate the impact of extracorporeal membrane oxygenation(ECMO) assisted beating heart coronary artery bypass graft(CABG) on inflammatory factors, and compare the result with conventional coronary artery bypass graft (CCABG) and off-pump coronary artery bypass graft(OPCABG).Method A total of45patients with coronary artery disease, underwent CABG, were included into this study.Inclusion criteria:Patients are at least55years old, whose angina pectoris frequently attacks and the medical treatment will not ease of coronary artery disease.Coronary angiography shows the stenosis of left main coronary artery is more than70%.Exclusion criteria:(1) Patients who have new myocardial infarction in recent3months.(2) Patients who had serious infections in recent3months.(3) Patients who had surgery in recent6months.(4)Patients had autoimmune diseases untreated. According to the different method of operation Patients are divided into three groups.Extracorporeal membrane oxygenation assisted Conventional CABG operation (group A)15cases, male11cases, female4cases, average age (62.3+/-4.8years old, weight (70.1+/-7.4Kg):the ECMO assisted off-pump CABG operation (group B)15cases, male9cases, female6cases, average age (73+/-4.4years old), weight (70.3+/-6.7Kg); the off-pump coronary artery bypass graft operation (group C)15cases, male8cases, female7cases, average age (63.1+/-5.9years old), weight (69.2+/-5.6Kg).The blood samples were collected at the moment preanesthesia(T1), after pump or ECMO starting10min(T2), pump or ECMO stopped or surgery finished moment(T3),4th hour after surgery(T4) and24th hour after surgery(T5). Centrifuged blood samples for plasma. Observe the change patterns of inflammatory cytokines tumor necrosis factor-a(TNF-α), interleukin-6(IL-6) and interleukin-8(IL-8) measured by enzyme-linked immune sorbent assay(ELISA).The statistical software SPSS17.0is used in statistical processing. Measurement data is expressed in mean differences±standard deviation (x±s). Chi-square analysis is chosen in count material.and repeated measurement data analysis of variance is chosen in different surgical procedures to the influence of three kinds of inflammatory factor, the diverse two comparison with SNK-q, P<0.05makes differences in a statistical significance.Result Gender and weight difference of patients was not statistically significant (P>0.05), and the age difference was statistically significant (P<0.05).Time effect of TNF-a, IL-6and IL-8, different surgical procedures, and two factors interaction effects in three groups of patients after operation are all statistically significant difference (P<0.01).There was significant trent about plasma level increase of inflammatory factors from T1to T4, and the plasma level reached peak at T4.Compared with Group A.the level of TNF-α、IL-6and IL-8was significant lower in group B and C (P<0.05),but it was not statistically signigicant between Group B and C(P>0.05).Conclusion Critical aging patients can be safe in ECMO-assisted CABG. Patients with serious left ventricle cardiac failure can be thoroughly revascularization, and can obtain good short-term curative effect can reduce the cardiopulmonary bypass(CPB) inflammation reaction, and the application of ECOM assisted CABG can remedy influence of moving heart in OPCABG and the cut of target blood vessels to rhythm of the heart and blood dynamics and uncompletely revascularization shortcomings, which has a good application prospect.