不停跳冠状动脉旁路移植术心肌保护技术对旁路移植合并瓣膜手术患者心肌保护的效果评价  

Myocardial protection technology for patients undergone off-pump coronary artery bypass grafting combined with valve surgery: a review on myocardial protective efficacy

作　　者：李红方[1] 李红英[1] 刘佳[1] Li Hongfang;Li Hongying;Liu Jia(Department of Cardiac Surgery,First Hospital of Hebei Medical University,Shijiazhuang 050030,China;不详)

机构地区：[1]河北医科大学第一医院心脏外科,石家庄050030

出　　处：《中国循证心血管医学杂志》2022年第12期1510-1513,1515,共5页Chinese Journal of Evidence-Based Cardiovascular Medicine

摘　　要：目的 不停跳冠状动脉(冠脉)旁路移植术心肌保护技术对旁路移植合并瓣膜手术患者心肌保护的效果评价。方法 选取2017年9月至2020年1月于河北医科大学第一医院行冠脉旁路移植术合并同期行瓣膜置换或修复术患者70例,根据术中采用的心肌保护技术不同分为研究组(38例)和对照组(32例),研究组在非体外循环下行心肌保护措施,对照组在体外循环下行心肌保护措施。观察两组围术期不同时间点心肌肌酸激酶同工酶(CK-MB)、心肌肌钙蛋白I(cTnI)水平,术前及术后3 d左室射血分数(LVEF)、左心室舒张末期内径(LVEDd)、左心房舒张末期内径(LAEDd)差异,术后3个月NYHA心功能分级,两组手术时间、重症监护病房(ICU)入住时间、总住院时间和24 h引流量,以及术后并发症发生情况。结果 两组患者术中1 h及术后12 h、1 d,CK-MB水平均升高,且术后1 d达到峰值,而后开始回落,研究组回落至术前水平,两组比较差异有统计学意义。研究组术中、术后不同时点CK-MB水平均低于对照组(P<0.01)。两组术毕、术后4 h、术后24 h,cTnI水平均渐升高,差异有统计学意义(P<0.01)。研究组术毕、术后4 h、术后24 h,cTnI水平均低于对照组(P<0.01)。两组手术前后及术后3 d LVEF水平比较,差异均无统计学意义(P>0.05)。术后3 d,两组LVEDd、LAEDd水平均降低,研究组显著低于对照组,差异有统计学意义(P<0.01)。研究组手术时间、ICU入住时间、总住院时间均低于对照组,24 h引流量少于对照组,差异有统计学意义(P<0.01)。术后3个月,研究组NYHA心功能分级情况优于对照组(P<0.01)。两组术后并发症发生率比较,差异无统计学意义(P=0.790)。结论 不停跳冠脉旁路移植术心肌保护技术可有效保护旁路移植合并瓣膜手术患者心肌功能,缩短手术时间,利于患者手术安全及术后康复。Objective To review the myocardial protective efficacy of myocardial protection technology in patients undergone off-pump coronary artery bypass grafting(CABG) combined with valve surgery. Methods The patients(n=70) received CABG and cardiac valve replacement or repair were chosen from the First Hospital of Hebei Medical University from Sept. 2017 to Jan. 2020. All patients were divided, according to different myocardial protection technologies, into study group(n=38) and control group(n=32). The study group was given off-pump CABG, and control group was given myocardial protective treatment of cardiopulmonary bypass(CPB). The levels of creatine kinase-MB isoenzyme(CK-MB) and cardiac troponin I(cTnI) at different perioperative time points,the differences in left ventricular ejection fraction(LVEF), left ventricular end-diastolic inner diameter(LVEDd)and left atrial end-diastolic inner diameter(LAEDd), and NYHA classification of heart function after 3 months,operation duration, ICU stay time, the total hospitalization time, 24 h drainage volume and incidence of postoperative complications were observed in 2 groups. Results The level of CK-MB increased during the operation for 1 h and after operation for12 h and 1 d, and reached the peak 1 d after operation then began to fall back in 2 groups, which reduced to prioperative level in study group, and the difference had statistical significance between 2 groups. The level of CK-MB was lower in study group than that in control group at different intraoperative and postoperative time points(P<0.01). The level of cTnI increased gradually in 2 groups at the end of operation, and 4 h and 24 h after operation(P<0.01). The level of cTnI was lower in study group than that in control group at the end of operation, and 4 h and 24 h after operation(P<0.01). The difference in LVEF level had no statistical significance between 2 groups before and 3 d after operation(P>0.05). The levels of LVEDd and LAEDd decreased in 2 group 3 d after operation,and they were significantly lower in

关 键 词：心脏瓣膜病 冠状动脉旁路移植术 心肌保护技术 术后并发症 

分 类 号：R654.2[医药卫生—外科学]