合并阻塞性睡眠呼吸暂停综合征患者行非体外循环冠脉搭桥手术围术期处理分析  

Evaluation of Perioperative Management in Coronary Artery Disease Patients with Obstructive Sleep Apnea Syndrome Undergoing off-pump Coronary Arteries bypass Grafting

作　　者：姚玮[1] 祁国奇[1] 刘苏[1] 赵宏[1] 陈子英[1] 刘林力[1] 

机构地区：[1]河北医科大学第二医院心外科,河北省石家庄市050000

出　　处：《中国全科医学》2010年第8期860-863,共4页Chinese General Practice

摘　　要：目的探讨合并阻塞性睡眠呼吸暂停综合征(OSAS)患者行非体外循环冠脉搭桥手术(OPCABG)围术期处理对手术预后的影响。方法选择欲行OPCABG的合并中、重度OSAS的患者30例,分为处理组(12例)和对照组(18例)。比较两组患者的术后并发症、预后及血清可溶性细胞间黏附分子-1(ICAM-1)、血管细胞黏附分子-1(VCAM-1)和内皮素-1(ET-1)水平手术前后的变化。结果处理组患者的术后拔管时间、ICU停留时间、术后住院时间明显短于对照组,差异有统计学意义(P<0.01);处理组患者的血清ICAM-1、VCAM-1、ET-1水平均低于对照组,差异有统计学意义(P<0.001);术后两组患者的心房纤颤、主要不良心脏事件(MACE)及静脉桥病变的发生情况比较差异无统计学意义(P>0.05);处理组患者术后血清ICAM-1、VCAM-1、ET-1水平低于术前(P<0.05);而对照组患者上述各指标手术前后比较差异无统计学意义(P>0.05)。结论合并OSAS患者行OP-CABG,围术期处理可以改善内皮功能和手术预后;但不能降低术后房颤、MACE和静脉桥血管病变的发生率。Objective To investigate the effectiveness of perioperative management in patients with coronary artery disease （CAD） combined with obstructive sleep apnea syndrome （OSAS） undergoing off pump coronary arteries bypass grafting （OPCABG）.Methods Thirty CAD patients with moderate or severe degree of OSAS undergoing OPCABG were divided into groups treatment （n=12） and control （n=18）.The postoperative complications and prognosis and the changes of plasma concentration of serum soluble intercellular adhesion molecule-1（sICAM-1） and endothelin-1 （ET-1） and vascular cell adhesion molecule-1 （VCAM-1） were detected.Results The postoperative extubation time,ICU stay,postoperative stay time were shorter in treatment group than in control,the difference was significant （P〈0.01）.The levels of serum ICAM-1,VXAM-1,ET-1 were lower in treatment group than in control,the difference was significant （P〈0.01）.There was not significant difference in atrial fibrillation,major adverse cardiac events （MACE） and vein graft lesion between 2 groups after operation （P〉0.05）.ICAM-1,VCAM-1,ET-1 levels were lower after operation than before（P〈0.05）.No significant difference was noted in the above indexes between pre-and post-operations in control group（P〉0.05）.Conclusion Perioperative management can improve endothelial function and postoperative prognosis but can not reduce postoperative atrial fibrillation,MACE and vein graft lesions in CAD patients with OSAS undergoing OPCABG.

关 键 词：阻塞性睡眠呼吸暂停综合征 非体外循环冠脉搭桥手术 围术期处理 

分 类 号：R654.33[医药卫生—外科学] R56[医药卫生—临床医学]