老年患者不同术式冠状动脉旁路移植围术期心脏泵血功能和对心肌影响的程度比较  

Comparison of hemodynamics and myocardial zymogram in elderly patients receiving off-pump versus on- pump coronary artery bypass grafting perioperatively

作　　者：王怀斌[1] 甄文俊[1] 欧阳小康[1] 马玉健[1] 谭洁[1] 罗文琦[1] 

机构地区：[1]卫生部北京医院心血管外科,100730

出　　处：《中华老年医学杂志》2013年第1期18-21,共4页Chinese Journal of Geriatrics

摘　　要：目的比较老年患者接受体外循环和非体外循环2种冠状动脉旁路移植（CABG）术式围手术期心脏泵血功能和对心肌影响的程度。方法40例65岁以上老年冠心患者分别在off-pump[（心脏不停跳组），20例]和on-pump[（心脏停跳组），20例]下行CABG。监测记录术前、术毕、术后第1天晨的心排指数（cI）和体循环阻力指数（SVRI）。分别于术前、术毕、术后第1、2、7天晨取静脉血标本，测定心肌肌钙蛋白T（cTNT）和肌酸激酶同工酶（CK～MB）的浓度。结果术后CI较术前升高，其中心脏不停跳组术毕较心脏停跳组升高更明显[（3．92±0．43）L·min-1·m-2比（3．81±0．52）L·min-1·m-2,t=2．036，P〈0．053。术后SVRI较术前降低，组间相同时间点比较差异无统计学意义（P〉0．05）。术毕cTNT和CK—MB开始升高，至术后第7天晨恢复正常。其中心脏停跳组术毕CK—MB明显高于心脏不停跳组[（11．8±4．4）μg／L比（8．4±4．3）μg／L，t=2．214，P〈0．05）；术后第1天晨cTNT明显高于心脏不停跳组[（0．23±0．12）μg／L比（0．11±0．09）μg／L，t=2．189，P％0．053。结论心脏不停跳CABG术式比停跳术式更能及时有效改善老年冠心病患者心脏泵血功能，提供更好的心肌保护。Objective To investigate the changes of hemodynamics, cardiac troponin T（cTNT） and CK-MB zymogram perioperatively in elderly patients receiving off-pump versus on-pump coronary artery bypass grafting （CABG）. Methods Totally 40 elderly patients （age〉65 years） undergoing surgical revascularization in our hospital were reviewed. 20 patients were received off-pump coronary artery bypass grafting （group A）, 20 patients received on-pump surgery （group B）. The cardiac output index （CI） and systemic vascular resistance index （SVRI） of each patient were recorded at the time of preoperative （T1）, surgery completion （T2） and first day after surgery （T3）. cTNT and CK- MB of all patients were detected perioperatively. Results The level of CI was increased after operation, whereas CI of group A in T2 was significantly higher than that of group B [（3.92±0.43） L·min-1·m-2＆ （3.81±0.52）L·min-1·m-2 , t=2. 036, P〈0. 05）. SVRI was decreased after operation, there was no difference between the two groups during the same time （P〈0.05）. The levels of cTNT and CK-MB were within normal range before operation, whereas enhanced immediately after operation and returned to normal within the 7th day. The level of CK-MB in group B after operation was higher than that in groupA [（11. 8±4.4）vg/L vs. （8.4±4.3）vg/L, t=2.214, P〈 0.05） ;The level of cTNT in group B at 1st day after operation was increaesd compared with that in group A [（0.23±0.12）μg/L vs. （0.11 ±0.09）μg/L, t=2. 189, P〈0.05）. Conclusions Both off-pump and on-pump CABG could improve the cardiac output and get approving myocardial protection effects in elderly patients, the effect of off-pump CABG might be superior to that of onpump CABG comparatively.

关 键 词：冠状动脉旁路移植术 非体外循环 手术期间 肌钙蛋白 肌酸激酶 

分 类 号：R654.2[医药卫生—外科学]