CAJ | 학술논문

目的探讨非体外循环(CPB)冠状动脉旁路移植术患者围术期血浆血管加压素(VP)和血管紧张素Ⅱ( Ang Ⅱ)的变化及其对转归的影响.方法择期行非CPB冠状动脉旁路移植术患者50例,性别不限,年龄45～79岁,ASA分级和心功能NYHA分级Ⅰ-Ⅲ级.分别于麻醉诱导前(T1,基础状态)、切皮前(T2)、切皮后10 min(T3)、30 min(T4)、给予鱼精蛋白后10 min(T5)、术毕(T6)、术后24h(T7)时采集动脉血样,测定血浆VP及AngⅡ的浓度.记录患者围术期临床资料.根据术中血浆VP浓度的不同,采用系统聚类分析方法将患者分为高值组(n=26)和低值组(n=24).采用logistic回归分析筛选低血VP浓度的危险因素.结果与高值组比较,低值组T2～T6时血浆VP浓度降低,血浆Ang Ⅱ浓度升高,术中血管麻痹发生率升高,术中及术后扩血管药物使用率降低,气管导管拔除时间、ICU停留时间和术后住院时间延长,术前左室射血分数(LVEF)降低(P＜0.05或0.01).logistic回归分析结果表明,术前低LVEF是术中低血VP浓度的危险因素,比值比为1.122(P＜0.01).结论非CPB冠状动脉旁路移植术患者术中血VP和Ang Ⅱ浓度变化趋势相反；低血VP浓度患者术中血管麻痹发生率升高,术后转归较差；术前低LVEF是术中低血VP浓度的危险因素.
목적 탐토비체외순배(CPB)관상동맥방로이식술환자위술기혈장혈관가압소(VP)화혈관긴장소Ⅱ( Ang Ⅱ)적변화급기대전귀적영향.방법 택기행비CPB관상동맥방로이식술환자50례,성별불한,년령45～79세,ASA분급화심공능NYHA분급Ⅰ-Ⅲ급.분별우마취유도전(T1,기출상태)、절피전(T2)、절피후10 min(T3)、30 min(T4)、급여어정단백후10 min(T5)、술필(T6)、술후24h(T7)시채집동맥혈양,측정혈장VP급AngⅡ적농도.기록환자위술기림상자료.근거술중혈장VP농도적불동,채용계통취류분석방법장환자분위고치조(n=26)화저치조(n=24).채용logistic회귀분석사선저혈VP농도적위험인소.결과여고치조비교,저치조T2～T6시혈장VP농도강저,혈장Ang Ⅱ농도승고,술중혈관마비발생솔승고,술중급술후확혈관약물사용솔강저,기관도관발제시간、ICU정류시간화술후주원시간연장,술전좌실사혈분수(LVEF)강저(P＜0.05혹0.01).logistic회귀분석결과표명,술전저LVEF시술중저혈VP농도적위험인소,비치비위1.122(P＜0.01).결론 비CPB관상동맥방로이식술환자술중혈VP화Ang Ⅱ농도변화추세상반；저혈VP농도환자술중혈관마비발생솔승고,술후전귀교차；술전저LVEF시술중저혈VP농도적위험인소.
Objective To investigate the relatioaship between the changes in perioperative plasma vasopressin (VP) and angiotensin Ⅱ ( Ang Ⅱ ) concentrations and outcome in patients undergoing off-pump coronary attery bypass grafting (OPCABG).Methods Fifty ASA Ⅰ -Ⅲ patients (NYHA Ⅰ -Ⅲ ) of both sexes,aged 45-79yr,undergoing OPCABG,were enrolled in this study.Blood samples were collected before induction of anesthesia (T1,baseline),before skin incision (T2),at 10 and 30 min after skin incision (T3,T4 ),10 min after protamine injection (T5),end of operation (T6 ) and 24 h after operation (T7).Based on the intraoperative plasma VP concentrations,the patients were divided into high level group ( n =26) and low level group ( n =24) by hierarchical clustering analysis.The risk factors for perioperative lower plasma VP concentration were determined by logistic regression analysis.Results Plasma VP concentrations were significantly lower,while plasma Ang Ⅱ concentrations were significantly higher at T2-6 in the low level group than in the high level group.The incidence of vasoplegia (high cardiac output and low peripheral resistance) was significantly higher,the intra- and post-operative use of vasodilator was less,the tracheal extubation time,ICU stay and post-operative hospital stay were longer,and preoperative left ventricular ejection fraction (LVEF) was lower in low level group than in high level group.Logistic regression analysis showed that preoperative low LVEF was a risk factor for intraoperative low plasma VP concentration and OR was 1.122.Conclusion Plasma VP and Ang Ⅱ concentrations demonstrate an opposite trend of change during OPCABG.The incidence of vasoplegic syndrome is significantly higher and the outcome poor in low plasma VP group.Preoperative low LVEF is a risk factor for development of low plasma VP during OPCABG.