Perioperative Indicators of Stress Response and Postoperative Inflammatory Complications in Patients Undergoing Off-Pump Coronary Artery Bypass Surgery : A Prospective Observational Study
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概要
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Background Little has been published regarding the association between perioperative stress response and clinical outcomes after off-pump coronary artery bypass surgery (OPCAB). The role of perioperative stress response in postoperative inflammatory complications (PIC) in patients undergoing OPCAB was assessed. Methods and Results The study cohort consisted of 100 patients who underwent elective OPCAB over a 5-month period. Anesthetic management was standardized and blood samples were collected before surgery, immediately after surgery, and 1, 2, 3, and 7 days after surgery. Leukocyte, neutrophil, platelet, erythrocyte sedimentation rate, C-reactive protein, fibrinogen, cortisol, D-dimer, and fibrin degradation product were measured at each time point, and the association of each parameter with PIC was assessed. PIC included postoperative pulmonary complications, atrial fibrillation, and wound infections. PIC occurred in 30 patients at the median third postoperative day. Multivariate analysis showed preoperative cortisol (p=0.024) and cortisol on the first postoperative day (p=0.001) were significantly associated with PIC. Intraoperative cortisol release was correlated with intraoperative hemodynamic changes, including pulmonary artery pressure, central venous pressure, and cardiac index. Conclusions Patients with PIC after OPCAB have significantly increased preoperative cortisol and cortisol on the first postoperative day. Intraoperative cortisol release was significantly correlated with hemodynamic changes. The neurohormonal environment and inflammatory response during and after beating-heart surgery should be further explored.
- 2008-11-20
著者
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YOUN Young-Nam
Department of Thoracic and Cardiovascular Surgery, Yonsei Cardiovascular Hospital, Yonsei University
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Yoo Kyung-Jong
Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine
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Song Suk-Won
Department of Thoracic and Cardiovascular Surgery, Yongdong Severance Hospital
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Yi Gijong
Department of Thoracic and Cardiovascular Surgery, Yongdong Severance Hospital
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Lee Sak
Department of Thoracic and Cardiovascular Surgery, Yonsei Cardiovascular Hospital, Yonsei University
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Sul Soon-Young
Department of Thoracic and Cardiovascular Surgery, Yonsei Cardiovascular Hospital, Yonsei University
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Yi Gijong
Department Of Thoracic And Cardiovascular Surgery Yonsei Cardiovascular Hospital Yonsei University H
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Song Suk-won
Department Of Thoracic And Cardiovascular Surgery Yonsei Cardiovascular Hospital Yonsei University H
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Song Suk-won
Department Of Thoracic And Cardiovascular Surgery Gangnam Severance Hospital Yonsei University Colle
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Youn Young-nam
Department Of Thoracic And Cardiovascular Surgery College Of Medicine Yonsei University
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Sul Soon-young
Department Of Thoracic And Cardiovascular Surgery Yonsei Cardiovascular Hospital Yonsei University H
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Yoo Kyung-jong
Department Of Thoracic And Cardiovascular Surgery Yonsei Cardiovascular Hospital Yonsei University H
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Yoo Kyung-jong
Department Of Thoracic And Cardiovascular Surgery Yonsei Cardiovascular Center Yonsei University Col
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Lee Sak
Department Of Thoracic And Cardiovascular Surgery Yonsei Cardiovascular Hospital Yonsei University H
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Youn Young-nam
Department Of Thoracic And Cardiovascular Surgery Yonsei Cardiovascular Hospital Yonsei University H
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