非体外循环冠脉搭桥术的心肌保护作用  

Myocardial Protective Effect of Off-Pump Coronary Artery Bypass Grafting

作　　者：姜春力[1] 谷天祥[1] 章志伟[1] 吴朝晖[1] 高锐[1] 

机构地区：[1]中国医科大学附属第一医院心脏外科,辽宁沈阳110001

出　　处：《中国医科大学学报》2003年第6期534-536,共3页Journal of China Medical University

摘　　要：目的 :比较非体外循环冠脉搭桥手术 (OPCAB)和体外循环冠脉搭桥手术 (CABG)围术期心肌损伤程度 ,探讨OPCAB的心肌保护效果。方法 :5 0例病人分为两组 ,A组 2 0例 ,为CABG组 ,B组 30例 ,为OPCAB组。分别于麻醉诱导后、手术结束后即刻、术后 2 4h、72h、16 8h取静脉血标本 ,分别测定心肌肌钙蛋白I水平和CK MB活性 ;另外记录围手术期各项临床指标。结果 :OPCAB组术后辅助呼吸时间较体外组短 (P <0 .0 1) ,而且房颤的发生率较低 (P <0 .0 5 )。CABG组与OPCAB组cTnI、CK MB的术前水平相似 ,而术后即刻、术后 2 4h、72h均较OPCAB组明显升高 (P <0 .0 5或 0 .0 1)。结论 :与CABG相比 ,OPCAB的心肌损伤较轻 ,心肌保护效果较好。Objective: Our aim was to investigate the protective effect of coronary artery bypass grafting (CABG) with or without cardiopulmonary bypass (CPB) on myocardial injury. Methods: Fifty patients undergone simple CABG were divided into 2 groups:CABG group (n=20),on pump with conventional CPB and cardioplegic arrest,and OPCAB group (n=30),off pump on the beating hearts. Serum level of cardiac troponin I (cTnI) and CK MB activity were determined right after anesthetic and 0,24,72 and 168 hours after operation. Results: The cTnI and CK MB increased significantly in the CABG group 0,24,72 hours after operation. The incidence of atrial fibrillation was higher and mechanical ventilatory support time was longer in CABG group than those in OPCAB greup (P<0.05 ). Conclusion: Off pump coronary artery bypass grafting on beating heart can reduce myocardial injury.

关 键 词：非体外循环 冠状动脉旁路移植术 心肌保护 

分 类 号：R654.2[医药卫生—外科学]