体外循环辅助心脏不停跳冠脉搭桥术治疗重症冠心病的效果研究  

Study on the effect of extracorporeal circulation-assisted on-pump coronary artery bypass grafting in the treatment of severe coronary heart disease

作　　者：王振雷 牟伟峰 WANG Zhen-lei;MOU Wei-feng(Department of Critical Care Medicine,Fangzi District People's Hospital,Weifang 261200,China)

机构地区：[1]潍坊市坊子区人民医院重症医学科,261200

出　　处：《中国实用医药》2023年第12期39-42,共4页China Practical Medicine

摘　　要：目的 探讨体外循环辅助心脏不停跳冠状动脉(冠脉)搭桥术治疗重症冠心病(CHD)的效果。方法 84例行冠脉搭桥术治疗的重症CHD患者,随机分为对照组和观察组,每组42例。对照组患者使用体外循环停跳技术,观察组患者使用体外循环辅助心脏不停跳技术。比较两组各项手术及恢复指标,术后不良心血管事件发生率及死亡率,术前及术后1个月心功能指标[左室射血分数(LVEF)、左室舒张末期内径(LVEDd)]及炎性因子[肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、中性粒细胞计数]。结果 观察组手术时间(101.52±30.14)min、体外循环时间(86.11±27.85)min、术后重症加强护理病房(ICU)停留时间(53.42±21.57)h、呼吸机使用时间(19.10±7.25)h、住院时间(7.41±1.28)d短于对照组的(148.27±43.52)min、(119.94±35.18)min、(89.83±34.61)h、(31.06±11.83)h、(12.35±2.26)d,新鲜冰冻血浆输注量(540.65±210.96)ml少于对照组的(674.52±262.37)ml,差异具有统计学意义(P<0.05)。两组组术后不良心血管事件发生率及死亡率比较差异无统计学意义(P>0.05)。术后1个月,两组LVEF、LVEDd比较差异无统计学意义(P>0.05);观察组TNF-α(33.46±8.29)pg/ml、IL-6(42.19±5.65)pg/ml、中性粒细胞计数(9.10±2.04)×10^(9)/L均低于对照组的(45.17±9.18)pg/ml、(57.21±5.98)pg/ml、(11.39±2.74)×10^(9)/L,差异具有统计学意义(P<0.05)。结论 体外循环辅助心脏不停跳冠脉搭桥术治疗重症CHD的效果显著,可缩短手术时间,减少手术创伤,保障术后心功能的恢复,且术后炎症反应程度轻,安全性高,不良心血管事件及死亡率均较低,具有积极的临床意义。Objective To discuss the effect of extracorporeal circulation-assisted on-pump coronary artery bypass grafting in the treatment of severe coronary heart disease(CHD).Methods A total of 84 patients with severe CHD who underwent coronary artery bypass grafting were randomly divided into control group and observation group,with 42 cases in each group.The control group received off-pump cardiopulmonary bypass,and the observation group received on-pump cardiopulmonary bypass.Both groups were compared in terms of surgical and recovery indexes,postoperative adverse cardiovascular events and mortality,cardiac function indexes[left ventricular ejection fraction(LVEF),left ventricular end-diastolic diameter(LVEDd)]and inflammatory factors[tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),neutrophil counts]before and 1 month after surgery.Results In the observation group,the operating time was(101.52±30.14)min,the duration of extracorporeal circulation was(86.11±27.85)min,the duration of ICU stay was(53.42±21.57)h,the duration of ventilator use was(19.10±7.25)h,and the length of hospital stay was(7.41±1.28)d,which were shorter than those of(148.27±43.52)min,(119.94±35.18)min,(89.83±34.61)h,(31.06±11.83)h,and(12.35±2.26)d in the control group;the infusion volume of fresh frozen plasma of(540.65±210.96)ml in the observation group was less than that of(674.52±262.37)ml in the control group;the differences were statistically significant(P<0.05).There was no statistically significant difference in the incidence of postoperative adverse cardiovascular events and mortality between the two groups(P>0.05).1 month after surgery,there was no statistically significant difference in LVEF and LVEDd between the two groups(P>0.05).The observation group had TNF-αof(33.46±8.29)pg/ml,IL-6 of(42.19±5.65)pg/ml,and neutrophil count of(9.10±2.04)×10^(9)/L,which were lower than those of(45.17±9.18)pg/ml,(57.21±5.98)pg/ml,and(11.39±2.74)×10^(9)/L in the control group,and the differences were statistically significant(P<0.05)

关 键 词：重症冠心病 体外循环辅助 心脏不停跳 冠状动脉搭桥术 效果 

分 类 号：R654.2[医药卫生—外科学]