不停跳冠状动脉旁路移植术后早期心肌微循环灌注变化的影响因素分析  

Early influencing factors analysis of myocardial microcirculatory perfusion after off-pump coronary artery bypass graft

作　　者：刘巍 高峰[1] 史泽鹏 高洋[1] 石磊[1] 王文君 张博[2] 张琳[1] 崔明静 庄熙晶[1] 何学志[1] LIU Wei;GAO Feng;SHI Zepeng;GAO Yang;SHI Lei;WANG Wenjun;ZHANG Bo;ZHANG Lin;CUI Mingjing;ZHUANG Xjing;HE Xuezhi(Department of Cardiovascular Surgery,Dalian Municipal Central Hospital,Dalian 116033,China)

机构地区：[1]大连市中心医院心脏大血管外科,116033 [2]大连市中心医院超声科,116033 [3]大连医科大学研究生院

出　　处：《临床外科杂志》2023年第7期617-621,共5页Journal of Clinical Surgery

摘　　要：目的探究不停跳冠状动脉旁路移植术(off-pump coronary artery bypass graft,OPCABG)术后影响早期心肌微循环灌注恢复的相关因素。方法2019年6月~2021年2月我院心脏大血管外科行OPCABG治疗的病人100例,根据术后早期各节段心肌灌注恢复情况将病人分为两组,A组76例,灌注均改善,B组24例,遗留灌注改善不佳。比较两组病人术前性别、年龄、体质指数(BMI)、高血压、糖尿病、血脂异常、吸烟、饮酒、代谢疾病、经皮冠状动脉介入治疗术史、超敏肌钙蛋白T(cTnI-T)、B型利钠肽(BNP)及心脏超声结果。结果B组和A组年龄分别为(71.63±5.09)岁和(64.74±9.45)岁、BMI分别为(29.27±3.56)kg/m^(2)和(26.09±3.08)kg/m^(2),糖尿病患病率分别为87.5%和21.1%,血脂异常发生率分别为70.8%和9.2%,两组比较,差异有统计学意义(P<0.05);两组病人性别、高血压患病率、吸烟率、饮酒率、代谢疾病患病率、经皮冠状动脉介入治疗术史、cTnI-T、BNP及心脏结构情况比较,差异无统计学意义(P>0.05)。Logistic回归建模结果示,年龄(OR:1.240,95%CI:1.080~1.486)、糖尿病患病情况(OR:0.086,95%CI:0.014~0.391)、血脂异常(OR:0.047,95%CI:0.007~0.220)可作为OPCABG术后早期遗留节段改善不佳的危险因素,且其预测效果较好(AUC=0.934,P<0.001)。年龄、血脂异常、糖尿病病史、BMI之间并未见明显协同效应(P>0.05)。结论年龄、糖尿病病史及血脂异常可作为预测OPCABG术后心肌微循环灌注改善情况的危险因素,其在保证较高的灵敏性及特异性的同时可较为准确地预测OPCABG病人术后早期微循环的改善情况。Objective Exploring the factors associated with the recovery of early myocardial microcirculatory perfusion after OPCABG.Methods Retrospective analysis of 100 patients treated with OPCABG in the department of cardiovascular surgery from June 2019 to February 2021.Patients were divided into two groups according to the recovery of myocardial perfusion in each segment in the early postoperative period.Group A:76 patients with improved perfusion in all segments and Group B:24 patients with poor perfusion improvement left in some segments.We compared the pre-procedure gender composition,age,BMI,hypertension,diabetes,dyslipidaemia,smoking,alcohol consumption,metabolic disease,history of PCI,cTnI-T,BNP and cardiac echocardiography results between the two groups.Results Age[(71.63±5.09)y vs.(64.74±9.45)y],BMI[(29.27±3.56)kg/m^(2) vs.(26.09±3.08)kg/m^(2)],prevalence of diabetes(87.5%vs.21.1%)and incidence of dyslipidemia(70.8%vs.9.2%)were significantly higher in Group B than in Group A,and the difference was statistically significant(P<0.05).No statistically significant differences were seen in the gender composition,prevalence of hypertension,smoking,alcohol consumption,prevalence of metabolic disease,history of PCI,cTnI-T,BNP and cardiac structure between the two groups(P>0.05).Logistic regression modelling showed that age(OR:1.240,95%CI:1.080-1.486),prevalence of diabetes(OR:0.086,95%CI:0.014-0.391)and the occurrence of dyslipidaemia(OR:0.047,95%CI:0.007-0.220)were risk factors for poor improvement of the residual segment in the early postoperative period after OPCABG,and that they were good predictors(AUC=0.934,P<0.001).No significant coefficients were seen between age,dyslipidemia,history of diabetes and BMI(P>0.05).Conclusion Age,history of diabetes and dyslipidaemia as risk factors for predicting improvement in myocardial microcirculatory perfusion after OPCABG.They can predict the improvement of microcirculation in the early postoperative period in OPCABG patients with high sensitivity and specificity.

关 键 词：不停跳冠状动脉搭桥术 心肌灌注 微循环 影响因素 

分 类 号：R654.2[医药卫生—外科学]