姚滨 蒋红英 夏正远 黄志勇

    【摘要】 目的 观察体外循环冠状动脉(冠脉)旁路移植术中吸烟患者血浆15-F F2t -isoprostane(15-F F2t -IsoP)的变化及其与术后心功能恢复的关系。方法 选择30例吸烟冠心病患者及30例非吸烟冠心病患者,均在异丙酚、芬太尼复合麻醉及体外循环下行冠脉旁路移植术。分别于麻醉诱导后手术前(T0)、主动脉阻断后30 min(T1)、主动脉开放后10 min(T2)及30 min(T3)经中心静脉抽血，测血浆游离15-F F2t -IsoP浓度。结果 T0时吸烟及非吸烟组血浆15-F F2t -IsoP浓度差异无显著性。T1时两组血浆15-F F2t -IsoP显著升高(与T0比较，P均<0.01)，此时吸烟组15-F F2t -IsoP的升高幅度显著高于非吸烟组(P<0.05)。再灌注期(T2、T3)吸烟组血浆15-F F2t -IsoP浓度下降速度较非吸烟组为慢，术后更多患者需血管活性药物支持。结论吸烟者体内抗氧化能力降低，增加了心脏手术后心功能障碍的发生率。

    【关键词】 吸烟； 冠状动脉旁路移植术; 15- F2t -isoprostane; 心功能,术后

    Change in plasma free 15-F2t-isoprostane concentrations in smoking patients undergoing coronary artery bypass grafting and its clinical significance YAO Bin, JIANG Hong-ying, XIA Zheng-yuan, HUANG Zhi-yong.Department of Anesthesiology, Sun Yat-sen Cardiovascular Hospital, Shenzhen 518020, Guangdong, China

    OBJECTIVE: To investigate the change in plasma free 15-F2t-isoprostane (15-F2t-IsoP) concentration and its relationship with postoperative cardiac function of smoking patients who underwent coronary artery bypass grafting (CABG).METHODS: Sixty patients with coronary artery heart disease were divided into smoking group [n=30, age 54-69 years old, American Heart Association (AHA)II-III] and non-smoking group(n=30, age 58-70 years old, ASA II-III). All the patients were scheduled for CABG under combination anesthesia with isoflurane and fentanyl and conventional cardiopulmonary bypass. Blood samples were drawn from the central vein to measure 15-F2t-IsoP at the following time points: before operation (T0); 30 minutes after aortic clamping for cardiopulmonary bypass (T1); 10 and 30 minutes after aortic decamping (T2, T3). RESULTS: There was no statistical difference in 15-F2t-IsoP between two groups at T0, but contents of 15-F2t-IsoP in the two groups was increased markedly at T1, compared to those at T0 (P<0.05 and P<0.01 for smoking and non-smoking groups, respectively), and the degree of increase of 15-F2t -IsoP in smoking group was significantly higher than that in non-smoking group (P<0.05). During reperfusion period (at T2, T3), the rate of lowering of 15-F2t-IsoP in smoking group was slower than that in non-smoking group (P<0.05), and moreover, these patients needed more inotropic support than those in non-smoking group. CONCLUSION: Smoking patients have weaker anti-oxidation capability during CABG, therefore they have higher incidence of low cardiac function. ......