非体外循环与常规体外循环下冠状动脉旁路移植术后肝肾功能的变化(英文)  

Changes in liver and renal function following coronary artery bypass grafting: Off-pump versus on-pump

作　　者：任崇雷[1] 高长青[1] 肖苍松[1] 吴扬[1] 邓学峰[1] 

机构地区：[1]解放军总医院心血管外科全军心脏外科研究所,北京市100853

出　　处：《中国组织工程研究与临床康复》2008年第40期7939-7942,共4页Journal of Clinical Rehabilitative Tissue Engineering Research

基　　金：the Scientific Research Foundation of Preeminence Youth in Medicine of Chinese PLA,No.04J017~~

摘　　要：背景:非体外循环冠状动脉旁路移植逐渐取代传统的体外循环下冠状动脉旁路移植而成为冠心病外科治疗的发展方向,但两种手术方式对肝肾功能的影响仍有待观察。目的:分析非体外循环下冠状动脉旁路移植术和体外循环下冠状动脉旁路移植术后肝肾功能的变化规律。设计、时间及地点:对比观察实验,于2005-06/11在解放军总医院心血管外科完成。对象:选择2005-06/2005-11在解放军总医院心血管外科50例进行择期冠状动脉旁路移植手术患者,所有患者术前肝肾功能均正常,无严重急性肝、肾功能不全。方法:根据患者意愿及病情匹配原则将所有患者分为非体外循环下冠状动脉旁路移植术组(30例)和体外循环下冠状动脉旁路移植术组(20例),分别行非体外循环下冠状动脉旁路移植术和体外循环下冠状动脉旁路移植术。两组患者在年龄、性别、体质量指数、术前射血分数、术前肝肾功能及手术危险因素等方面无明显差异(P>0.05)。主要观察指标:两组患者分别于术前及术后1d,1及2周抽血测定血丙氨酸氨基转移酶,天冬氨酸转氨酶,尿素氮及肌酐值评价患者肝肾功能。结果:纳入患者50例患者均进入结果分析。①肝功能变化:非体外循环下冠状动脉旁路移植术组患者术后第1天血丙氨酸氨基转移酶及天冬氨酸转氨酶明显低于体外循环下冠状动脉旁路移植术组,差异比较有显著性意义(P<0.05),两组患者血丙氨酸氨基转移酶及天冬氨酸转氨酶水平于术后2周内恢复至术前正常水平。②肾功能变化:非体外循环下冠状动脉旁路移植术组患者术后第1天血尿素氮及肌酐值明显低于体外循环下冠状动脉旁路移植术组,差异比较有显著性意义(P<0.05),两组患者血尿素氮及肌酐值于术后2周内恢复至术前正常水平。结论:冠状动脉旁路移植术对肝肾功能均有一定的损害,但在术后早期均可恢复;�BACKGROUND： On-pump coronary artery bypass grafting （CABG） is replaced by off-pump coronary artery bypass grafting step by step. Effects of the two operations on liver and renal function deserve further studies. OBJECTIVE： To analyze the postoperative changes in liver and renal function between off-pump and on-pump CABG. DESIGN, TIME AND SETTING： Controlled study. The experiment was conducted at the Department of Cardiovascular Surgery General Hospital of Chinese PLA, Beijing between June and November 2005. PARTICIPANTS： Fifty patients undergoing elective CABG at General hospital of PLA from June to November 2005 were enrolled in the study. All patients had normal liver and renal function before surgery. None of them developed severe acute liver and renal function. METHODS： All patients were allocated to either off-pump coronary bypass （OPCAB） （n=30） or on-pump conventional CABG （CCABG） （n=20） group according to patient＇s intention and condition. No significant difference was detected in age, gender, body mass index, preoperative ejection fraction, preoperative liver and renal function and operation risk factors between both groups （P 〉 0.05）. MAIN OUTCOME MEASURES： Alanine aminotransferase （ALT）, aspartate aminotransferase （AST）, blood urea nitrogen （BUN） and creatinine （Cr） were respectively measured in patients of both groups before surgery, 1 day, 1 week and 2 weeks after surgery. RESULTS： A total of 50 patients were involved in the final analysis. Changes in liver function： Serum ALT and AST levels in the OPCAB group were significantly lower than those in the CCABG group at 1 day after surgery （P 〈 0.05）. The level of two parameters recovered to the baseline at 2 week after surgery in both group. Changes in renal function： Serum BUN and Cr levels in the OPCAB group were significantly lower compared to the CCABG group at the first postoperative day （P 〈 0.05）. BUN and Cr levels recovered to the preoperative levels at 2 weeks after surge

关 键 词：冠状动脉分流术 肝脏功能 肾脏 功能 

分 类 号：R622.4[医药卫生—整形外科]