非体外循环与体外循环下冠状动脉搭桥术对冠心病患者远期预后的影响  

Effects of Off-pump and On-pump Coronary Artery Bypass Graft on Long-term Prognosis of Patients with Coronary Heart Disease

作　　者：王立 张婷 郑霄 吕向妮 徐学增 WANG Li;ZHANG Ting;ZHENG Xiao;LYU Xiang-ni;XU Xue-zeng(Department of Cardiovascular Surgery,the First Affiliated Hospital of PLA Air Force Military Medical University,Xi'an 710032)

机构地区：[1]中国人民解放军空军军医大学第一附属医院心血管外科,西安710032

出　　处：《解放军医药杂志》2020年第12期27-31,共5页Medical & Pharmaceutical Journal of Chinese People’s Liberation Army

基　　金：国家重点研发计划课题任务书(2016YFC1301902)。

摘　　要：目的探讨非体外循环与体外循环下冠状动脉搭桥术对冠心病患者远期预后的影响。方法回顾性分析2017年9月—2018年3月行冠状动脉搭桥术治疗冠心病患者87例的临床资料,根据手术方式分为非体外组49例和体外组38例,非体外组采用非体外循环下冠状动脉搭桥术,体外组采用体外循环下冠状动脉搭桥术。比较2组围术期相关指标及远期预后情况。结果非体外组监护室观察时间、气管插管时间、住院时间、手术时间均短于体外组,出血量少于体外组(P<0.01)。术后,非体外组肌钙蛋白I、肌酸激酶同工酶、左心室舒张末期内径、血肌酐、尿素氮、N-乙酰-β-D-葡萄糖苷酶、脑钠肽均低于体外组,且肌酐清除率、第1秒用力呼气容积、用力肺活量均高于体外组(P<0.05)。非体外组并发症总发生率低于体外组(P<0.05)。随访2年,非体外组胸闷和心绞痛症状、新发ST-T改变发生率显著高于体外组(P<0.05)。结论非体外循环下冠状动脉搭桥术对冠心病患者疗效较佳,对心肌功能、肺功能及肾功能的损伤低于体外循环治疗,但远期胸闷和心绞痛症状、新发ST-T改变发生率较高。Objective To investigate the effects of off-pump and on-pump coronary artery bypass graft on long-term prognosis of patients with coronary heart disease(CHD).Methods The clinical data of 87 patients with CHD who underwent coronary artery bypass graft(CABG)from September 2017 to March 2018 were retrospectively analyzed.According to the surgical method,they were divided into off-pump group(n=49)and on-pump group(n=38).The off-pump group underwent off-pump CABG,and the on-pump group underwent on-pump CABG.The perioperative indexes and long-term prognosis of the two groups were compared.Results The observation time in ICU,tracheal intubation time,length of hospital stay and duration of operation of off-pump group were significantly shorter than those of on-pump group,and blood loss was significantly less than that of on-pump group(P<0.01).After operation,troponin I,creatine kinase-MB,left ventricular end-diastolic diameter,serum creatinine,urea nitrogen,N-acetyl-β-D-glucosidase and brain natriuretic peptide of off-pump group were significantly lower than those of on-pump group,and creatinine clearance rate,forced expiratory volume in 1 second and forced vital capacity were significantly higher than those of on-pump group(P<0.05).The total incidence of complications in off-pump group was significantly lower than that in on-pump group(P<0.05).At 2-year follow-up,the incidences of chest tightness,angina pectoris and new ST-T changes in off-pump group were significantly higher than those in on-pump group(P<0.05).Conclusion Off-pump CABG has a better effect on patients with CHD,and the damage to myocardial function,lung function and renal function is lower than that of cardiopulmonary bypass,while the incidence of long-term chest tightness,angina symptoms and new ST-T changes is higher.

关 键 词：冠心病 冠状动脉旁路移植术 非体外循环 体外循环 肌钙蛋白I 血尿素氮 用力肺活量 预后 

分 类 号：R541.4[医药卫生—心血管疾病]