分站式杂交手术在多支冠状动脉病变中的应用效果及对血清心肌损伤标志物、心功能的影响  

Application Effect of Substation Hybrid Operation in Multi-vessel Coronary Artery Disease and Its Effect on Serum Myocardial Injury Markers and Cardiac Function

作　　者：王茜[1] 王大玮 沙博欣 晋美 王欣 WANG Qian;WANG Da-wei;SHA Bo-xin;JIN Mei;WANG Xin(Department of Cardiovascular Medicine,the Second Central Hospital of Baoding City,Zhuozhou,Hebei 072750,China;Department of Stroke Center,the First Hospital of Baoding City,Baoding,Hebei 071000,China;Department of Cardiovascular Medicine,Yixian Hospital of Traditional Chinese Medicine,Yixian,Hebei 071000,China)

机构地区：[1]保定市第二中心医院心血管内科,河北涿州072750 [2]保定市第一医院卒中中心,河北保定071000 [3]易县中医医院心血管内科,河北易县071000

出　　处：《临床误诊误治》2023年第2期68-72,共5页Clinical Misdiagnosis & Mistherapy

基　　金：保定市计划项目(2141ZF026)。

摘　　要：目的探究分站式杂交手术在多支冠状动脉病变中的应用效果及对血清心肌损伤标志物、心功能、主要心脑血管不良事件(MACCE)发生风险的影响。方法选取2020年5月-2021年5月收治的多支冠状动脉病变80例,根据手术方式不同分为对照组和研究组,各40例。对照组采用非体外循环冠状动脉旁路移植术(OPCAB)治疗,研究组采用分站式杂交手术治疗。比较2组围术期情况、心功能、血清心肌损伤标志物[心肌型肌酸激酶同工酶(CK-MB)、心肌肌钙蛋白I(cTnI)、氨基末端脑钠肽前体(NT-proBNP)]及载脂蛋白B(ApoB)、载脂蛋白A1(ApoA1)、ApoB/ApoA1比值水平;术后随访1年,比较2组MACCE发生率。结果研究组手术时间、监护室时间、机械通气时间短于对照组,出血量、红细胞输注量、术后24 h引流量少于对照组(P<0.01);术后3 d,研究组血清CK-MB、cTnI、NT-proBNP水平低于对照组(P<0.05,P<0.01);术后3 d,2组血清ApoB、ApoB/ApoA1比值低于术前,ApoA1高于术前,NYHA分级优于术前(P<0.05),但组间比较差异无统计学意义(P>0.05);2组MACCE发生率比较差异无统计学意义(P>0.05)。结论采用分站式杂交手术治疗多支冠状动脉病变能改善患者心功能,有效减轻手术创伤,降低术后血清心肌损伤标志物水平。Objective To explore the application effect of substation hybrid operation in multi-vessel coronary artery disease and its effect on serum myocardial injury markers,cardiac function,and the risk of major adverse cardiovascular and cerebrovascular events(MACCE).Methods A total of 80 patients with multi-vessel coronary artery disease in our hospital from May 2020 to May 2021 were selected and divided into control group(n=40)and research group(n=40)according to different surgical methods.The control group was treated with off-pump coronary artery bypass grafting(OPCAB),and the research group was treated with substation hybrid surgery.The perioperative conditions,cardiac function,serum myocardial injury markers[phosphocreatine kinase isoenzyme(CK-MB),cardiac troponin I(cTnI),amino-terminal brain natriuretic peptide precursor(NT-proBNP)]and the levels of apolipoprotein B(ApoB),apolipoprotein A1(ApoA1),and ApoB/ApoA1 ratio were compared between the two groups.The patients were followed up for 1 year after surgery,and the incidence of MACCE was compared between the two groups.Results The duration of operation,length of ICU stay and duration of mechanical ventilation of the research group were shorter than those of the control group,and the amount of blood loss,red blood cell infusion and 24 h postoperative drainage volume were shorter or less than those of the control group(P<0.01).At 3 d after surgery,the serum levels of CK-MB,cTnI and NT-proBNP in the research group were lower than those in the control group(P<0.05,P<0.01).At 3 d after surgery,serum ApoB,and ApoB/ApoA1 ratio in the two groups were lower than those before surgery,ApoA1 was higher than that before surgery,and New York Heart Association(NYHA)grade was superior to that before surgery(P<0.05),but there was no statistical significance between the two groups(P>0.05).There was no significant difference in the incidence of MACCE between the two groups(P>0.05).Conclusion Substation hybrid operation in the treatment of multi-vessel coronary artery disease can im

关 键 词：冠状动脉疾病 分站式杂交手术 冠状动脉旁路移植术 非体外循环 肌钙蛋白I 载脂蛋白类 心脑血管不良事件 

分 类 号：R541.4[医药卫生—心血管疾病]