术前主动脉内球囊反搏在冠状动脉旁路移植术的应用效果分析  

Preoperative intra-aortic balloon counteration in coronary bypass grafting

作　　者：袁超[1] 王笑天 常峰荣 吕智超 郭长英[1] YUAN Chao;WANG Xiaotian;CHANG Fengrong;LV Zhichao;GUO Changying(Department of CSICU,the Seventh People's Hospital of Zhengzhou,Zhengzhou 450000,China)

机构地区：[1]郑州市第七人民医院CSICU,450000

出　　处：《心肺血管病杂志》2025年第2期161-166,共6页Journal of Cardiovascular and Pulmonary Diseases

基　　金：2020度河南省医学科技公关计划联合共建项目(HG20200734)。

摘　　要：目的:探讨术前主动脉内球囊反搏(intra-aortic balloon pump,IABP)辅助治疗在重症冠心病非体外循环冠状动脉旁路移植术(off-pump coronary artery bypass,grafting,OPCAB)中的应用效果。方法:收集2018年1月至2022年12月,郑州市第七人民医院重症冠心病OPCAB手术患者85例临床资料,根据术前是否行IABP辅助治疗分为IABP组(44例)、非IABP组(41例)。比较两组手术前后血清炎性因子(IL-6、IL-10、TNF-α)、心肌损伤标志物(cTnI、CK-MB)、术后30d并发症及预后情况。结果:术后24h,IABP组血清IL-6、TNF-α低于非IABP组,IL-10高于非IABP组(P<0.05);血清cTnI、CK-MB低于非IABP组(P<0.05)。术后30天,IABP组血小板减少、心律失常、低心排血量、中转体外循环及死亡率低于非IABP组(6.8%vs.22.0%,13.6%vs.31.7%,6.8%vs.24.4%,0.0%vs.29.3%,2.3%vs.14.6%)(χ^(2)=4.009,3.993,5.059,14.995,4.291,P<0.05)。结论:术前IABP辅助OPCAB治疗能够减少重症冠心病患者围术期并发症及死亡率,可能与缓解炎症反应、减轻心肌损伤程度等因素有关。Objective:To investigate the effect of preoperative intra-aortic balloon pump(IABP)adjuvant therapy in off-pump coronary artery bypass grafting(OPCAB)of severe coronary heart disease.Methods:From January 2018 to December 2022,85 patients with severe coronary heart disease undergoing OPCAB surgery in Zhengzhou Seventh People's Hospital were collected and divided into IABP group(44 cases)and non-IABP group(41 cases)according to whether they received IABP adjuvant therapy before surgery.Serum inflammatory factors(IL-6,IL-10,TNF-α)were compared between the two groups before and after operation,myocardial injury markers(cTnI,CK-MB)and prognosis 30 days after operation were compared between the two groups.Results:24h after operation,serum IL-6 and TNF-αin IABP group were lower than those in non-IABP group,and serum IL-10 was higher than those in non-IABP group(P<0.05).Serum cTnI and CK-MB were lower than those in non-IABP group(P<0.05).At 30 days after surgery,the rates of thrombocytopenia,ventricular arrhythmia,low cardiac output,conversion cardiopulmonary bypass,mortality in the IABP group were lower than those in the non-IABP group(6.8%vs.22.0%,13.6%vs.31.7%,6.8%vs.24.4%,0.0%vs.29.3%,2.3%vs.14.6%)(χ^(2)=4.009,3.993,5.059,14.995,4.291,P<0.05).Conclusions:Preoperative IABP assisted OPCAB treatment can reduce perioperative complications and mortality in patients with severe coronary heart disease,which may be related to alleviating inflammation and myocardial injury.

关 键 词：主动脉内球囊反搏 非体外循环冠状动脉旁路移植术 重症冠心病 炎性因子 心肌损伤 

分 类 号：R54[医药卫生—心血管疾病]