微体外循环对冠状动脉搭桥术后全身炎症反应和输血需求的影响  

Impact of Minimally Invasive Extracorporeal Circulation on Systemic Inflammatory Response and Transfusion Requirements after Coronary Artery Bypass Grafting

作　　者：周晓娟 杨立斌 杨鹏 龚浩 杨旭[1] ZHOU Xiaojuan;YANG Libin;YANG Peng;GONG Hao;YANG Xu(Department of Cardiovascular Surgery,Affiliated Hospital of Yunnan University,Kunming Yunnan 650021,China)

机构地区：[1]云南大学附属医院心血管病中心外科,云南昆明650021

出　　处：《昆明医科大学学报》2025年第3期58-65,共8页Journal of Kunming Medical University

基　　金：云南省科技厅-昆明医科大学联合专项基金项目(202101AY070001-284)。

摘　　要：目的研究旨在探讨微体外循环(Minimally Invasive Extracorporeal Circulation,MECC)对冠状动脉搭桥术(coronary artery bypass grafting,CABG)后全身炎症反应和输血需求的影响。方法选取2023年1月至2024年1月接受CABG的126例患者,随机分为观察组和对照组,每组各63例。观察组采用MECC,对照组采用传统体外循环(conventional extracorporeal circulation,CECC)。分别在术前及术后24 h、48 h和72 h监测两组患者的炎症反应指标、免疫系统功能、凝血功能、肾功能、心脏功能及临床症状,并进行比较分析。结果术后24 h,观察组C-反应蛋白(C-reactive protein,CRP)、白细胞介素-6(Interleukin-6,IL-6)和肿瘤坏死因子-α(Tumor Necrosis Factor-alpha,TNF-α)水平分别为(18.5±3.7)mg/L、(15.2±3.4)pg/mL和(25.3±5.6)pg/mL,显著低于对照组(P<0.05)。术后48 h,观察组CD4阳性细胞(CD4-positive T cells,CD4+)/CD8阳性细胞(CD8-positive T cells,CD8+)比值为(1.6±0.3),高于对照组(P<0.05)。术后72 h,观察组的凝血酶原时间(prothrombin time,PT)和激活部分凝血活酶时间(activated partial thromboplastin time,APTT)分别为(12.1±1.2)s和(30.4±3.2)s,显著低于对照组(P<0.05)。同时,术后72 h,观察组的血清肌酐(Serum Creatinine,SCr)和血尿素氮(Blood Urea Nitrogen,BUN)分别为(1.1±0.2)mg/d L和(14.6±3.1)mg/d L,显著低于对照组(P<0.05)。在心脏功能指标方面,术后24 h,观察组的心脏指数(cardiac index,CI)、左心室射血分数(left ventricular ejection fraction,LVEF)、心肌肌钙蛋白I(cardiac troponin I,cTnI)和B型利钠肽(B-type natriuretic peptide,BNP)分别为(2.6±0.5)L/min/m^(2)、(55.6±4.0)%、(0.14±0.03)ng/mL和(280±30)pg/mL,均显著优于对照组(P<0.05)。术后各时间点,观察组的视觉模拟评分(visual analog scale,VAS)、并发症发生率、住院时间和重症监护病房(intensive care unit,ICU)停留时间均显著优于对照组(P<0.05),如术后24 h VAS评分为(4.8±1.2),而对照组为(5.5±1.3),P<0.05。结论MECObjective This study aims to explore the effects of Minimally Invasive Extracorporeal Circulation(MECC)on systemic inflammatory response and transfusion requirements following Coronary Artery Bypass Grafting(CABG).Methods A total of 126 patients who underwent CABG from January 2023 to January 2024 were selected and randomly divided into an observation group and a control group,with 63 patients in each group.The observation group received MECC,while the control group was treated with Conventional Extracorporeal Circulation(CECC).Inflammatory response indicators,immune system function,coagulation function,renal function,cardiac function,and clinical symptoms were monitored preoperatively and at 24,48,and 72 hours postoperatively for comparison and analysis.Results At 24 hours postoperatively,CRP,IL-6 and TNF-αlevels in the observation group were(18.5±3.7)mg/L,(15.2±3.4)pg/mL and(25.3±5.6)pg/mL,respectively,which were significantly lower than those in the control group(P<0.05).At 48 hours postoperatively,the CD4+/CD8+ratio in the observation group was 1.6±0.3,which was higher than that in the control group(P<0.05).At 72 hours postoperatively,the PT and APTT in the observation group were(12.1±1.2)seconds and(30.4±3.2)seconds,respectively,which were significantly lower than those in the control group(P<0.05).Additionally,72 hours after surgery,SCr and BUN in the observation group were(1.1±0.2)mg/dL and 14.6±3.1 mg/dL,respectively,which were significantly lower than those in the control group(P<0.05).In terms of cardiac function indexes,at 24 hours postoperatively,CI,LVEF,cTnI and BNP in the observation group were(2.6±0.5)L/min/m^(2),(55.6±4.0)%,(0.14±0.03)ng/mL,and(280±30)pg/mL,respectively,which were significantly better than those in the control group(P<0.05).At all postoperative time points,the VAS score,complication rate,length of hospital stay and ICU stay were significantly better in the observation group than in the control group(P<0.05),with the VAS score at 24 hours postoperatively being(4.8±1.2

关 键 词：微体外循环 冠状动脉搭桥术 炎症反应 输血需求 

分 类 号：R147.252[医药卫生—公共卫生与预防医学]