左胸小切口在非体外循环下冠状动脉搭桥术中的应用效果及对创伤反应、凝血功能、疼痛介质及预后的影响  

Effect of Mini Incision on the Left Chest in Off-pump Coronary Artery Bypass Grafting and the Influence on Traumatic Response,Coagulation Function,Pain Mediators,and Prognosis

作　　者：杨婷婷 武菲菲 苏洁 张绡绮 赵俊霞 杨晶 段维勋 YANG Tingting;WU Feifei;SU jie;ZHANG Xiaoqi;ZHAO Junxia;YANG Jing;DUAN Weixun(First Affiliated Hospital of Air Force Medical University,Xi′an 710032,Shaanxi,China)

机构地区：[1]中国人民解放军空军军医大学第一附属医院,西安710032 [2]中国人民解放军空军军医大学

出　　处：《中西医结合心脑血管病杂志》2022年第10期1741-1745,共5页Chinese Journal of Integrative Medicine on Cardio-Cerebrovascular Disease

基　　金：国家自然科学基金项目(No.81870218)。

摘　　要：目的 探讨左胸小切口在非体外循环下实施冠状动脉搭桥术中应用效果及对创伤反应、凝血功能、疼痛介质及预后的影响。方法选取2017年2月—2019年4月于空军军医大学第一附属医院实施非体外循环下冠状动脉搭桥术的病人105例,依据治疗方案不同分为小切口组(53例)与常规组(52例)。小切口组行左胸小切口手术,常规组行常规胸骨正中切口。比较两组围术期手术有关指标与术前、术后第1天、术后第3天血清创伤反应指标[皮质醇(Cor)、去甲肾上腺素(NE)、C反应蛋白(CRP)、白细胞介素-6(IL-6)]、凝血功能指标[活化部分凝血活酶时间(APTT)、D-二聚体(D-D)、纤维蛋白原(FIB)]、疼痛介质[P物质(SP)、神经肽Y(NPY)]水平,统计术后并发症发生率与术后1年预后情况。结果 小切口组住院时间、重症监护室(ICU)监护时间、呼吸机应用时间、切口长度短于常规组(P<0.05),术后24 h引流量低于常规组(P<0.05);小切口组术后第1天、第3天血清Cor、NE、CRP、IL-6、SP、NPY水平低于常规组(P<0.05);小切口组术后第1天、第3天APTT、D-D水平较常规组降低,FIB水平较常规组升高(P<0.05);小切口组术后并发症发生率为5.66%,低于常规组的21.15%(P<0.05);两组术后1年心绞痛、桥血管闭塞、死亡比例比较,差异均无统计学意义(P>0.05)。结论 左胸小切口应用于非体外循环下冠状动脉搭桥术病人可减轻手术创伤反应,减少疼痛介质分泌,降低对凝血功能的影响,减少并发症,且预后良好。Objective To investigate the effect of mini incision on the left chest in off-pump coronary artery bypass grafting and its influence on patients′trauma response,coagulation function,pain mediators,and prognosis.Methods From February 2017 to April 2019,105 patients underwent off-pump coronary artery bypass grafting were selected and divided into mini incision group(53 cases)and conventional group(52 cases)according to different treatment plans.The patients in mini incision group received mini incision on the left chest,and the patients in conventional group received conventional sternal midline incision.The perioperative indexes,serum trauma response indexes[cortisol(Cor),norepinephrine(NE),C-reactive protein(CRP),interleukin-6(IL-6)],coagulation function indexes[activated partial thromboplastin time(APTT),D-dimer(D-D),fibrinogen(FIB)],pain mediators[substance P(SP),neuropeptide Y(NPY)]levels before operation,1 day and 3 days after operation were compared between two groups.The incidence of postoperative complications and prognosis of 1 year after surgery were calculated.Results The hospitalization time,intensive care unit(ICU)monitoring time,ventilator application time,and incision length of mini incision group were shorter than those of conventional group(P<0.05),and the drainage volume at 24 h after surgery was lower than that of conventional group(P<0.05).The serum levels of Cor,NE,CRP,IL-6,SP,and NPY in mini incision group were lower than those in conventional group at 1 day and 3 days after operation(P<0.05).The APTT and D-D levels of mini incision group were lower than those of conventional group at 1 and 3 days after operation,and the FIB level was higher than that of conventional group(P<0.05).The incidence of postoperative complications in mini incision group was 5.66%,which was lower than 21.15%in conventional group(P<0.05).There was no significant difference in the proportion of angina pectoris,vascular graft occlusion,and deaths between two groups at 1 year after surgery(P>0.05).Conclusion The mini

关 键 词：非体外循环下冠状动脉搭桥术 左胸小切口 创伤反应 凝血功能 疼痛介质 

分 类 号：R65[医药卫生—外科学]