NSTEMI患者行非体外循环下冠状动脉旁路移植术的时机选择  

Optimal timing of off-pump coronary artery bypass graft surgery in patients with non-ST-segment elevation myocardial infarction

作　　者：李森[1] 叶晓峰[1] 朱云鹏[1] 李海清[1] 王哲[1] 陈安清[1] 刘俊[1] 周密[1] 蔡俊峰[1] 赵强[1] LI Sen YE Xiaofeng ZHU Yunpeng LI Haiqing WANG Zhe CHENAnqing LIU Jun ZHOU Mi CAI Junfeng ZHAO Qiang(Department of Cardiac Surgery,Ruijin Hospital,Shanghqi Jiaotong University School of Medicine,Shanghqi 200025, Chin)

机构地区：[1]上海交通大学医学院附属瑞金医院心脏外科,200025

出　　处：《国际心血管病杂志》2017年第3期168-171,共4页International Journal of Cardiovascular Disease

摘　　要：目的:探讨非ST段抬高型急性心肌梗死(NSTEMI)患者行非体外循环下冠状动脉旁路移植术(OPCAB)的时机选择。方法:回顾性分析我院心脏外科2009年5月至2015年5月完成的261例行OPCAB的NSTEMI患者资料,按术前心肌肌钙蛋白Ⅰ(cTnⅠ)水平分为两组。A组cTnⅠ>0.15ng/mL(n=103),B组cTnⅠ≤0.15ng/mL(n=158),比较两组患者手术时间、血流动力学参数、术后住院时间及术后并发症等情况。结果:术后30d内A组死亡4例(3.9%),B组死亡2例(1.3%),两组比较无统计学差异(P>0.05)。多因素分析提示高龄、术前cTnⅠ>0.15ng/mL、NSTEMI后10d内手术为术后30d内主要心脑血管不良事件(MACCEs)发生的独立危险因素(P<0.05)。结论:为减少术后MACCEs事件的发生,建议于发生NSTEMI 10d后,且cTnⅠ降至0.15ng/mL以下时行OPCAB术。Objective：To investigate the timing of off-pump coronary artery bypass graft surgery（OPCAB）for patients with non-ST-segment elevation myocardial infarction（NSTEMI）. Methods：A retrospective study was performed in 261 NSTEMI patients who had undergone OPCAB from May 2009 to May 2015 in our center.These patients were divided into two groups according to the preoperative cardiac troponin I（cTnⅠ）levels as group A（cTnⅠ〉0.15 ng/mL,103 cases）and group B（cTnⅠ≤0.15 ng/mL,158 cases）.The operation duration,hemodynamic parameter,postoperative hospital stay and complications were analyzed between two groups. Results：There were 4 cases（3.9%）in group A and 2 cases（1.3%）in group B died within 30 days after operation,and there was no significant difference of the 30-day mortality between the two groups（P〉0.05）.By multivariate logistic regression analysis,elder,cTnⅠ〉0.15 ng/mL and operation within 10 days after NSTEMI were independent risk factors of main adverse cardiovascular and cerebrovascular events（MACCEs）within 30-days after surgery（P 〈0.05）. Conclusions：To reduce the incidence of postoperative MACCEs,OPCAB is recommended to be performed at least 10 days after NSTEMI with cTnⅠ below0.15 ng/mL.

关 键 词：非ST段抬高型急性心肌梗死 非体外循环下冠状动脉旁路移植术 手术时机 心肌肌钙蛋白Ⅰ 

分 类 号：R654.2[医药卫生—外科学]