Relationship between perioperative changes in plasma arginine vasopressin and angiotensin Ⅱ and outcome in patients undergoing off-pump coronary artery bypass grafting
10.3760/cma.j.issn.0254-1416.2012.06.001
- VernacularTitle:非体外循环冠状动脉旁路移植术患者围术期血浆血管加压素和血管紧张素Ⅱ的变化及其对转归的影响
- Author:
Yanwei YANG
;
Shuwen LI
;
Weiping CHENG
;
Chengbin WANG
;
Xiulan LI
;
Yuxiang GAO
- Publication Type:Journal Article
- Keywords:
Vasopressins;
Angiotensin Ⅱ;
Prognosis;
Coronary artery bypass,off-pump
- From:
Chinese Journal of Anesthesiology
2012;32(6):653-656
- CountryChina
- Language:Chinese
-
Abstract:
ObjectiveTo 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).MethodsFifty 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.ResultsPlasma 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.
