α-Tocopherol and ascorbic acid in early postoperative period of cardiopulmonary bypass

摘要

AIM: To investigate whether α-tocopherol and ascorbic acid have effect on the suppression of inflammation in the early postoperative period after open heart surgery. METHODS: A total of 59 patients who had undergone cardiopulmonary bypass (CPB) in the Cardiovascular Surgery Department of a tertiary center between June 2008 and December 2008 were retrospectively investigated. The study group consisted of 34 patients (25 men, 9 women) to whom ascorbic acid (500mg/day) and α-tocopherol (300mg/day) were administered on the day of operation (0th day) and the first four consecutive postoperative days. In contrast, 25 controls (20 men, 5 women) received no additional anti-inflammatory medications. The two groups were compared in terms of demographics, blood parameters such as C-reactive protein (CRP) and white blood cell (WBC) count, and durations of cross-clamp and CPB. RESULTS: In the control group, CRP levels were found to be increased on the first postoperative day (P<0.001) and CRP levels were correlated with triglyceride levels on the day of operation (P=0.009) and the first postoperative day (P=0.021). On the second postoperative day WBC count was found to be decreased (P=0.008) and correlated with glucose level (P<0.005). In the study group, CRP levels were found to be inversely correlated with serum high-density lipoprotein (HDL) (P=0.049) on the first postoperative day and directly correlated with triglyceride levels on the second postoperative day (P=0.017). Blood glucose levels were found to be increased on the first postoperative day (P=0.021) and a correlation was detected between WBC count on the fourth postoperative day and doses of ascorbic acid and α-tocopherol (P=0.027). CONCLUSION: Suppression of the systemic inflammatory response to CPB is a double-edged sword and whether this suppression aids in the attenuation of morbidity and mortality is obscure. In this respect, ascorbic acid and α-tocopherol seem to display some anti-inflammatory effect, but further studies are necessary to reveal the actual therapeutic potential and the complex mechanism related to biochemical and inflammatory parameters.