Impact of Minimally Invasive Extracorporeal Circulation on Systemic Inflammatory Response and Transfusion Requirements after Coronary Artery Bypass Grafting
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摘要:
目的 研究旨在探讨微体外循环（Minimally Invasive Extracorporeal Circulation，MECC）对冠状动脉搭桥术（coronary artery bypass grafting，CABG）后全身炎症反应和输血需求的影响。 方法 选取2023年1月至2024年1月接受CABG的126例患者，随机分为观察组和对照组，每组各63例。观察组采用MECC，对照组采用传统体外循环（conventional extracorporeal circulation，CECC）。分别在术前及术后24 h、48 h和72 h监测两组患者的炎症反应指标、免疫系统功能、凝血功能、肾功能、心脏功能及临床症状，并进行比较分析。 结果 术后24 h，观察组C-反应蛋白（C-reactive protein，CRP）、白细胞介素-6（Interleukin-6，IL-6）和肿瘤坏死因子-α（Tumor Necrosis Factor-alpha，TNF-α）水平分别为（18.5±3.7） mg/L、（15.2±3.4） pg/mL和（25.3±5.6） pg/mL，显著低于对照组（P < 0.05）。术后48 h，观察组CD4阳性细胞（CD4-positive T cells，CD4+）/CD8阳性细胞（CD8-positive T cells，CD8+）比值为（1.6±0.3），高于对照组（P < 0.05）。术后72 h，观察组的凝血酶原时间（prothrombin time，PT）和激活部分凝血活酶时间（activated partial thromboplastin time，APTT）分别为（12.1±1.2） s和（30.4±3.2）s，显著低于对照组（P < 0.05）。同时，术后72 h，观察组的血清肌酐（Serum Creatinine，SCr）和血尿素氮（Blood Urea Nitrogen，BUN）分别为（1.1±0.2） mg/dL和（14.6±3.1） mg/dL，显著低于对照组（P < 0.05）。在心脏功能指标方面，术后24 h，观察组的心脏指数（cardiac index，CI）、左心室射血分数（left ventricular ejection fraction，LVEF）、心肌肌钙蛋白I（cardiac troponin I，cTnI）和B型利钠肽（B-type natriuretic peptide，BNP）分别为（2.6±0.5） L/min/m2、（55.6±4.0）%、（0.14±0.03） ng/mL和（280±30） pg/mL，均显著优于对照组（P < 0.05）。术后各时间点，观察组的视觉模拟评分（visual analog scale，VAS）、并发症发生率、住院时间和重症监护病房（intensive care unit，ICU）停留时间均显著优于对照组（P < 0.05），如术后24 hVAS评分为（4.8±1.2），而对照组为（5.5±1.3），P < 0.05。 结论 MECC在减轻CABG术后全身炎症反应、保护多系统功能、减少术后输血需求及改善术后恢复方面具有显著优势。与传统体外循环相比，MECC能有效降低术后炎症反应和并发症，提高患者术后的生活质量，具有广泛的临床应用前景。 Abstract:Objective This study aims to explore the effects of Minimally Invasive Extracorporeal Circulation （MECC） on systemic inflammatory response and transfusion requirements following Coronary Artery Bypass Grafting （CABG）. Methods A total of 126 patients who underwent CABG from January 2023 to January 2024 were selected and randomly divided into an observation group and a control group, with 63 patients in each group. The observation group received MECC, while the control group was treated with Conventional Extracorporeal Circulation （CECC）. Inflammatory response indicators, immune system function, coagulation function, renal function, cardiac function, and clinical symptoms were monitored preoperatively and at 24, 48, and 72 hours postoperatively for comparison and analysis. Results At 24 hours postoperatively, CRP, IL-6 and TNF-α levels in the observation group were （18.5±3.7） mg/L, （15.2±3.4） pg/mL and （25.3±5.6） pg/mL, respectively, which were significantly lower than those in the control group（P < 0.05）. At 48 hours postoperatively, the CD4+/CD8+ ratio in the observation group was 1.6±0.3, which was higher than that in the control group （P < 0.05）. At 72 hours postoperatively, the PT and APTT in the observation group were （12.1±1.2） seconds and （30.4±3.2） seconds, respectively, which were significantly lower than those in the control group （P < 0.05）. Additionally, 72 hours after surgery, SCr and BUN in the observation group were （1.1±0.2） mg/dL and 14.6±3.1 mg/dL, respectively, which were significantly lower than those in the control group （P < 0.05）. In terms of cardiac function indexes, at 24 hours postoperatively, CI, LVEF, cTnI and BNP in the observation group were （2.6±0.5） L/min/m2, （55.6±4.0）%, （0.14±0.03） ng/mL, and （280±30） pg/mL, respectively, which were significantly better than those in the control group（P < 0.05）. At all postoperative time points, the VAS score, complication rate, length of hospital stay and ICU stay were significantly better in the observation group than in the control group （P < 0.05）, with the VAS score at 24 hours postoperatively being （4.8±1.2） compared to （5.5±1.3） in the control group（P < 0.05）. Conclusions MECC demonstrates significant advantages in attenuating systemic inflammatory response after CABG, protecting multi-system function, reducing postoperative blood transfusion requirements, and improving postoperative recovery. Compared with traditional extracorporeal circulation, MECC effectively reduce postoperative inflammatory reactions and complications, enhancing the quality of life for patients post-surgery, and shows broad clinical application prospects. -
图 1 两组不同周期的炎症反应指标检测结果
Figure 1. Detection results of inflammatory response indicators in different cycles of two groups
图 2 两组不同周期凝血功能指标检测结果
Figure 2. Results of coagulation function indexes in different cycles of the two groups
表 1 炎症反应指标（CRP，IL-6，TNF-α）在不同时间点的检测结果（$\bar x \pm s $）
Table 1. Inflammatory response indicators （CRP，IL-6，TNF-α） at different time points （$\bar x \pm s $）
时间点 组别 CRP （mg/L） t P IL-6 （pg/mL） t P TNF-α （pg/mL） t P 术前 观察组 4.8 ± 1.2 0.211 0.830 3.5 ± 0.9 0.193 0.851 8.2 ± 2.3 0.282 0.781 对照组 4.7 ± 1.1 3.4 ± 0.8 8.1 ± 2.1 术后24 h 观察组 18.5 ± 3.7 2.733 0.013* 15.2 ± 3.4 2.854 0.012* 25.3 ± 5.6 2.912 0.013* 对照组 22.7 ± 4.3 18.9 ± 4.2 30.1 ± 6.4 术后48 h 观察组 14.2 ± 3.1 2.452 0.020* 12.4 ± 3.1 2.552 0.022* 20.1 ± 5.0 2.623 0.022* 对照组 17.6 ± 3.8 15.7 ± 3.6 24.5 ± 5.7 术后72 h 观察组 10.6 ± 2.8 2.291 0.033* 8.7 ± 2.5 2.361 0.024* 15.7 ± 4.3 2.411 0.020* 对照组 13.3 ± 3.4 11.2 ± 2.9 19.4 ± 5.1 *P < 0.05。 
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表 2 免疫系统功能指标（WBC，NLR，CD4+/CD8+比率，IgG，IgM）在不同时间点的检测结果（$\bar x \pm s $）
Table 2. Immune system function indicators （WBC，NLR，CD4+/CD8+ ratio，IgG，IgM） at different time points （$\bar x \pm s $）
时间点 组别 WBC
（×109/L）t P NLR t P CD4+/
CD8+比率t P IgG
（g/L）t P IgM
（g/L）t P 术前 观察组 7.2±1.8 0.252 0.831 2.5±0.6 0.192 0.85 1.8±0.5 0.222 0.821 11.5±2.3 0.321 0.751 1.1±0.3 0.271 0.794 对照组 7.1±1.7 2.4±0.5 1.9±0.6 11.3±2.2 1.0±0.2 术后24 h 观察组 9.8±2.4 2.591 0.024* 4.3±1.1 2.773 0.012* 1.5±0.4 2.693 0.010* 9.8±2.1 2.524 0.024* 0.9±0.2 2.654 0.012* 对照组 11.4±2.7 5.6±1.4 1.2±0.3 8.2±2.0 0.7±0.1 术后48 h 观察组 8.7±2.0 2.453 0.022* 3.8±0.9 2.681 0.011* 1.6±0.5 2.614 0.012* 10.3±2.3 2.392 0.020* 1.0±0.3 2.521 0.023* 对照组 10.1±2.5 4.9±1.2 1.3±0.4 8.8±2.1 0.8±0.2 术后72 h 观察组 7.9±1.9 2.293 0.031* 3.1±0.7 2.562 0.023* 1.7±0.4 2.424 0.023* 10.8±2.4 2.281 0.031* 1.0±0.3 2.363 0.020* 对照组 9.2±2.3 4.2±1.0 1.4±0.3 9.4±2.2 0.9±0.2 *P < 0.05。
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表 3 凝血功能指标（INR，APTT，FIB）在不同时间点的检测结果（$\bar x \pm s $）
Table 3. Coagulation indicators （INR，APTT，FIB） at different time points （$\bar x \pm s $）
时间点 组别 INR t P APTT （s） t P FIB （g/L） t P 术前 观察组 1.03 ± 0.12 0.282 0.781 32.5 ± 2.8 0.341 0.733 3.2 ± 0.5 0.313 0.761 对照组 1.02 ± 0.11 32.3 ± 2.7 3.3 ± 0.6 术后24 h 观察组 1.27 ± 0.14 2.691 0.010* 38.4 ± 3.2 2.612 0.014* 2.6 ± 0.4 2.714 0.012* 对照组 1.38 ± 0.15 41.6 ± 3.5 2.3 ± 0.3 术后48 h 观察组 1.21 ± 0.13 2.483 0.023* 36.1 ± 3.0 2.542 0.022* 2.8 ± 0.4 2.662 0.013* 对照组 1.31 ± 0.14 39.2 ± 3.3 2.5 ± 0.4 术后72 h 观察组 1.15 ± 0.12 2.312 0.032* 34.2 ± 2.9 2.430 0.020* 3.0 ± 0.5 2.591 0.010* 对照组 1.25 ± 0.13 37.4 ± 3.1 2.7 ± 0.4 *P < 0.05。
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表 4 肾功能指标（SCr，BUN，GFR）在不同时间点的检测结果（$\bar x \pm s $）
Table 4. Renal function indicators （SCr，BUN，GFR） at different time points （$\bar x \pm s $）
时间点 组别 SCr （μmol/L） t P BUN （mmol/L） t P GFR （mL/min/1.73m2） t P 术前 观察组 78.5 ± 15.2 0.323 0.761 5.8 ± 1.2 0.271 0.791 95.3 ± 10.4 0.284 0.783 对照组 79.2 ± 14.8 5.7 ± 1.1 94.8 ± 10.2 术后24 h 观察组 85.6 ± 16.4 2.521 0.023* 6.9 ± 1.4 2.491 0.024* 89.1 ± 9.8 2.612 0.014* 对照组 97.4 ± 18.2 8.2 ± 1.6 81.3 ± 9.5 术后48 h 观察组 82.3 ± 15.1 2.413 0.020* 6.4 ± 1.3 2.434 0.022* 91.7 ± 9.9 2.581 0.010* 对照组 93.6 ± 17.5 7.8 ± 1.5 84.2 ± 9.7 术后72 h 观察组 79.4 ± 14.7 2.294 0.033* 6.1 ± 1.2 2.362 0.020* 93.8 ± 10.1 2.453 0.022* 对照组 89.8 ± 16.8 7.4 ± 1.4 86.7 ± 10.0 *P < 0.05。
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表 5 心脏功能指标CI，LVEF，cTnI，BNP在不同时间点的检测结果（$\bar x \pm s $）
Table 5. Cardiac function indicators CI，LVEF，cTnI，BNP at different time points （$\bar x \pm s $）
时间点 组别 CI[L（min·m2）] t P LVEF （%） t P cTnI （ng/mL） t P BNP （pg/mL） t P 术前 观察组 2.8 ± 0.5 0.312 0.761 58.2 ± 4.3 0.292 0.773 0.02 ± 0.01 0.261 0.791 120 ± 25 0.334 0.741 对照组 2.7 ± 0.6 57.9 ± 4.5 0.02 ± 0.01 118 ± 24 术后24 h 观察组 2.6 ± 0.5 2.441 0.021* 55.6 ± 4.0 2.534 0.024* 0.14 ± 0.03 2.692 0.010* 280 ± 30 2.653 0.014* 对照组 2.3 ± 0.4 52.1 ± 3.8 0.18 ± 0.04 350 ± 35 术后48 h 观察组 2.7 ± 0.5 2.323 0.022* 56.3 ± 4.2 2.471 0.020* 0.10 ± 0.02 2.534 0.022* 240 ± 28 2.541 0.021* 对照组 2.4 ± 0.4 53.4 ± 3.9 0.14 ± 0.03 310 ± 32 术后72 h 观察组 2.8 ± 0.6 2.180 0.034* 57.2 ± 4.1 2.362 0.021* 0.08 ± 0.02 2.452 0.021* 210 ± 27 2.484 0.022* 对照组 2.5 ± 0.5 54.6 ± 4.0 0.12 ± 0.03 280 ± 30 *P < 0.05。
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表 6 临床症状（VAS评分、并发症发生率、住院时间、ICU停留时间）监测结果（$\bar x \pm s $）
Table 6. Results of monitoring clinical symptoms （VAS score，complication rate，length of hospital stay，ICU stay） （$\bar x \pm s $）
时间点 组别 t P 并发症
发生率 （%）χ2 P 住院
时间 （d）t P ICU停留
时间 （h）t P 术前 观察组 3.2 ± 1.0 0.313 0.761 − − − − − − − − − 对照组 3.1 ± 1.1 − − − − − − − − − 术后24 h 观察组 4.8 ± 1.2 2.441 0.021* 16.1 4.113 0.040* − − − 30.5 ± 5.3 2.383 0.020* 对照组 5.5 ± 1.3 32.3 − − − 36.4 ± 6.1 术后48 h 观察组 3.6 ± 1.1 2.322 0.020* 12.9 3.87 0.053 − − − − − − 对照组 4.2 ± 1.2 27.4 − − − − − − 术后72 h 观察组 2.9 ± 1.0 2.182 0.033* 9.7 3.54 0.064 10.3 ± 2.1 2.462 0.021* − − − 对照组 3.6 ± 1.1 22.6 13.6 ± 2.5 − − − *P < 0.05。
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表 7 炎症反应、免疫功能、凝血功能与输血需求的相关性分析
Table 7. Correlation analysis of inflammatory response，immune function，coagulation and transfusion requirements
指标 相关系数 P CRP （mg/L） −0.61 0.023* IL-6 （pg/mL） −0.55 0.029* TNF-α （pg/mL） −0.58 0.019* WBC （×109/L） −0.6 0.021* NLR −0.63 0.018* FIB （g/L） −0.72 0.012* CI （L/min/m2） −0.67 0.016* LVEF （%） −0.64 0.020* *P < 0.05。
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