体外循环与非循环冠状动脉旁路移植术对老年冠心病病人脏器损伤的影响

doi:10.3969/j.issn.1005-6483.2019.06.020

摘要/Abstract

摘要： 目的分析体外循环与非循环冠状动脉旁路移植术对老年冠心病病人脏器损伤的影响。方法老年冠心病病人144例，遵循随机对照试验原则行盲法分组，对照组72例，采取体外循环冠状动脉旁路移植术（CCABG），观察组72例，实施非体外循环冠状动脉旁路移植术（OPCAB）治疗，比较两组临床手术指标和并发症，监测术后不同时间节点心（CKMB、cTnI），肺（IO），肾（BUN、SCr），肝（AST、ALT）等脏器组织及颅脑（S100B蛋白）损伤情况，随访记录术后12个月心功能（LVEF、LVEDD）改善效果，以SF-36量表评估生活质量。结果两组手术手术操作时间、搭桥数目、术后24小时内引流量比较，差异无统计学意义（P＞0.05），观察组血浆、全血输注量、呼吸机应用、ICU入住时间及住院恢复时间、并发症低于对照组（P＜0.05）；观察组术毕即刻（T2）、术后24小时（T3）、术后48小时（T4）等时间节点AST、ALT、BUN、CKMB、SCr、cTn I、S100B蛋白均低于对照组，OI高于对照组（P＜0.05）；两组术后12个月LVEF、LVEDD比较差异无统计学意义（P＞0.05），观察组GH、RE、MH评分均高于对照组（P＜0.05）。结论 OPCAB与CCABG治疗老年冠心病均可造成脏器组织损伤，OPCAB对病人肺、心肌、肾、肝脏器及颅脑组织损伤程度均较CCABG治疗者更小，预后更佳。

关键词: 冠状动脉旁路移植术, 冠心病, 非体外循环, 脏器损伤

Abstract: Objective To investigate the effects of cardiopulmonary bypass（CPB）and off-circulation coronary artery bypass grafting（CABG）on visceral injury in elderly patients with coronary heart disease.Methods 144 elderly patients with coronary heart disease admitted in our hospital from July 2013 to June 2017 were divided into two groups：the control group（n=72）and the control group（n=72）treated with coronary artery bypass grafting（CCABG），）under cardiopulmonary bypass（CPB）.Off-pump coronary artery bypass grafting（OPCAB）was performed to compare the clinical indexes，complications，CK-MB，cTnI，（IO），kidney（BUN，SCr）of lung，liver（AST，ALT）and brain（S100B protein）injury between the two groups.The improvement of cardiac function（LVEF，LVEDD）was recorded 12 months after operation and the quality of life was evaluated with SF-36 scale.Results there was no significant difference in the operation time，the number of bypass grafts and the drainage volume within 24 hours after operation between the two groups（P>0.05）.The complications were significantly lower than those in the control group（P<0.05），and the protein of AST，ALT，BUN，CK-MB，SCr，cTn Igni S100B in the observation group was significantly lower than that in the control group at the end of operation（T2），24 hours（T3）and 48 hours（T4）after operation（P<0.05）.There was no significant difference in LVEF，LVEDD between the two groups at 12 months after operation（P>0.05）.The GH，RE，MH scores in the observation group were significantly higher than those in the control group（P<0.05）.Conclusion both CCABG and VOPCAB can cause visceral tissue injury in elderly patients with CHD.The degree of OPCAB injury to lung，myocardium，kidney，liver and craniocerebral tissue is smaller and the prognosis is better than that of CCABG.

Key words: Coronary artery bypass grafting, Coronary heart disease, Off-pump, Organ injury

魏凯, 王琪峰, 庞云峰. 体外循环与非循环冠状动脉旁路移植术对老年冠心病病人脏器损伤的影响[J]. 临床外科杂志, 2019, 27(6): 508-511.

WEI Kai, WANG Qifeng, PANG Yunfeng.. Effects of cardiopulmonary bypass and off-circulation coronary artery bypass grafting on visceral injury in elderly patients with coronary heart disease[J]. JOURNAL OF CLINICAL SURGERY, 2019, 27(6): 508-511.

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