非体外循环与改良灌注体外循环下冠状动脉旁路移植术对心肌损伤影响558例的回顾性队列研究  

Effect on myocardial injury between off-pump and modified perfusion on-pump coronary artery bypass grafting:A retrospective cohort study in 558 patients

作　　者：赵铁夫[1] 王盛宇[1] 张春晓[1] 张明[1] 曾文[1] 王坚刚[1] 郑帅[1] 陈宏[1] ZHAO Tiefu;WANG Shengyu;ZHANG Chunxiao;ZHANG Ming;ZENG Wen;WANG Jiangang;ZHENG Shuai;CHEN Hong(Department of Cardiac Surgery,Beijing Anzhen Hospital,Capital Medical University,Beijing,100029,P.R.China)

机构地区：[1]首都医科大学附属北京安贞医院心脏外科,北京100029

出　　处：《中国胸心血管外科临床杂志》2021年第1期81-86,共6页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的探讨体外循环下冠状动脉旁路移植术(ONCAB)与非体外循环冠状动脉旁路移植术(OPCAB)对心肌损伤的差异。方法2017~2019年北京安贞医院对558例冠状动脉粥样硬化性心脏病患者施行了冠状动脉旁路移植术,根据是否应用改良灌注的体外循环,将患者分为两组。OPCAB组(OP组):465例,男282例、女183例,年龄(63.58±7.87)岁;ONCAB组(ON组):93例,男64例、女29例,年龄(63.91±7.51)岁。观察两组患者术前24 h、术后30 min、12 h、36 h、48 h和6 d的肌酸激酶MB(CK-MB)及心肌损伤特异性指标—肌钙蛋白(c Tn I)。结果全部患者无围术期死亡。ON组术后12 h CK-MB(5.00 ng/m L vs.8.60 ng/m L,Z=–2.189,P=0.029)、c Tn I(3.00 ng/m L vs.7.80 ng/m L,Z=–5.307,P=0.000),术后36 h CK-MB(5.00 ng/m L vs.5.60 ng/m L,Z=–2.280,P=0.023)、c Tn I(0.10 ng/m L vs.1.02 ng/m L,Z=–6.418,P=0.000),术后48 h c Tn I(0.07 ng/m L vs.0.81 ng/m L,Z=–1.946,P=0.032),均低于OP组。结论ONCAB较OPCAB对心肌损伤更小。Objective To explore the difference of myocardial injury between off-pump coronary artery bypass grafting(OPCAB)and modified perfusion on-pump coronary artery bypass grafting(ONCAB).Methods A total of 558 patients who underwent coronary artery bypass grafting in Beijing Anzhen Hospital from 2017 to 2019 were included.According to whether or not they received modified perfusion cardiopulmonary bypass,all the 558 patients were divided into two groups including an OPCAB group(OP group)and an ONCAB group(ON group).There were 465 patients in the OP group including 282 males and 183 females with an average age of 63.58±7.87 years.In the ON group,there were93 patients including 64 males and 29 females with an average age of 63.91±7.51 years.Creatine kinase MB(CK-MB)and cardiac specific troponin I(c Tn I)were measured 24 hours before operation,30 minutes after operation,12 hours after operation,36 hours after operation and 48 hours after operation.Results No perioperative death occurred in all patients.CK-MB(5.00 ng/m L vs.8.60 ng/m L,Z=–2.189,P=0.029)and c Tn I(3.00 ng/m L vs.7.80 ng/m L,Z=–5.307,P=0.000)in postoperative 12 hours in the ON group were less than those in the OP group.CK-MB(5.00 ng/m L vs.5.60 ng/m L,Z=–2.280,P=0.023)and c Tn I(0.10 ng/m L vs.1.02 ng/m L,Z=–6.418,P=0.000)in postoperative 36 hours in the ON group were less than those in the OP group.c Tn I(0.07 ng/m L vs.0.81 ng/m L,Z=–1.946,P=0.032)in postoperative48 hours in the ON group was less than that in the OP group.Conclusion Compared with OPCAB,modified perfusion ONCAB has less myocardial damage.

关 键 词：体外循环冠状动脉旁路移植术 非体外循环冠状动脉旁路移植术 心肌损伤 外科手术 

分 类 号：R654.2[医药卫生—外科学]