内膜剥脱联合电熨烙术治疗弥漫性冠状动脉病变的初步探究  

Study on the coronary endarterectomy combined with electrocautery in the treatment of diffuse coronary artery disease

作　　者：汪川[1] 李同勋[1] 张帆[1] 顾承雄[1] 李京倖[1] Wang Chuan;Li Tongxun;Zhang Fan;Gu Chengxiong;Li Jingxing(Department of Cardiac Surgery,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院心外科,100029

出　　处：《中华胸心血管外科杂志》2020年第2期83-88,共6页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的探讨内膜剥脱联合电熨烙术改善弥漫性冠状动脉病变患者的外科疗效的初步应用结果及其机制。方法2017年1月至2018年9月于我科行冠心病外科治疗并拟行前降支内膜剥脱术患者,术前充分告知电熨烙等相关手术风险,签署知情同意书并进行随机分组,两组根据样本量统计各入组150例。研究组术中内膜剥脱术毕即刻行电熨烙术,对照组单纯行内膜剥脱术,两组均常规行冠状动脉旁路移植术,术后于2、24、72、120 h行心电图及血清学检查(肌钙蛋白I、白细胞介素6、肿瘤坏死因子-α)对比两组变化差异。术后1年随访患者心电图及超声心动图结果。结果两组患者术后心电图显示,研究组术后心电图ST段抬高9例,对照组术后心电图ST段抬高25例。于术后2、24、72、120 h酶联免疫法同时检测外周血中肌钙蛋白I、肿瘤坏死因子和白细胞介素6的含量,两组患者均呈现出肌钙蛋白I、肿瘤坏死因子-α和白细胞介素6的含量持续逐渐增高的趋势,并于24 h到达顶峰,后缓慢回落;研究组术后2 h肿瘤坏死因子-α含量显著低于对照组(P=0.01),肌钙蛋白I和白细胞介素6含量水平未见明显差异;研究组术后24、72、120 h肌钙蛋白I、肿瘤坏死因子-α和白细胞介素6的含量均显著低于对照组(P<0.05)。术后1年研究组ST段改变显著低于对照组,狭窄率和心肌梗死率差异无统计学意义。结论内膜剥脱联合电熨烙术在弥漫性冠状动脉病变患者外科手术中具有防止管腔狭窄、血液湍流,使血管内壁光滑的作用;减缓外周血中炎性因子释放,同时也抑制血管中炎性因子的表达,减轻心肌损伤。短期疗效满意,长期抗炎抗血栓效果及临床疗效仍需进一步研究。Objective To explore the outcomes and mechanisms of coronary endarterectomy combined with electrocautery in patients with diffused coronary artery disease undergoing coronary artery bypass grafting(CABG).Methods From January 2017 to September 2018,300 patients undergoing CABG with left anterior descending artery endarterectomy were randomly divided into two groups,after fully informed the risks and other related issues regarding the operations.All the patients in the two groups were treated with CABG.In the study group,patients underwent electrocautery immediately after endarterectomy,whereas in the control group,patients underwent endarterectomy only.The electrocardiogram and serological examination(TNI,IL-6 and TNF-a)were performed at 2 h,24 h,72 h and 120 h after operation.The follow-up duration was 1 year.Results Nine patients in the study group,and 25 patients in the control group had ST segment elevation.The levels of TNI,IL-6 and TNF-a were continuously increased in both groups,and reached the peak at 24 h,then decreased slowly.The levels of TNF-a were significantly lower at 2 h postoperatively in the study group(P=0.01).There was no significant difference in the levels of TNI and IL-6 between the two groups.The levels of TNI,TNF-a and IL-6 were significantly lower in the electrocautery group at 24 h,72 h,and 120 h after operation(P<0.05).One year after operation,incidences of ST segment elevation in the study group were significantly lower than that in the control group,and there was no significant difference in restenosis rate and myocardial infarction rate.Conclusion Endarterectomy combined with electrocautery may prevent the restenosis of the lumen and blood turbulence,smooth the inner wall of the vessel,slow down the release of inflammatory factors in the peripheral blood,inhibit the expression of inflammatory factors in the vessels,and reduce the myocardial damage.The short-term effect was satisfactory;the long-term anti-inflammatory and antithrombotic effect still need further investigations.

关 键 词：内膜剥脱 电熨烙 炎性反应 血栓形成 

分 类 号：R54[医药卫生—心血管疾病] R65[医药卫生—内科学]