重症冠状动脉粥样硬化性心脏病患者体外循环下心脏不停跳冠状动脉旁路移植术早期结果分析
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摘要
目的研究并探讨体外循环不停跳冠状动脉旁路移植术(CABG)在重症冠状动脉粥样硬化性心脏病(冠心病治疗中的临床疗效及安全性。方法选择2014年1月至2017年10月期间本院行传统体外循环停跳CABG与体外循环不停跳CABG的重症冠心病患者各50例进行回顾性研究,分别设置为停跳组、不停跳组,比较两组患者的桥血管数量、体外循环时间、呼吸机通气时间、ICU停留时间、住院时间、心肌肌钙蛋白水平、心功能指标、并发症发生率、死亡率。结果不停跳组的桥血管数量少于停跳组(P <0.05),其体外循环时间、呼吸机通气时间、ICU停留时间、住院时间均短于停跳组(P <0.05)。两组治疗后的肌钙蛋白(c Tn) I、c Tn T均较治疗前显著降低(P <0.05),而在治疗后,不停跳组的c Tn I、c Tn T均低于停跳组(P <0.05)。两组治疗后的左室射血分数、6 min步行距离均较治疗前显著提高(P <0.05),其N末端脑钠肽前体较治疗前显著降低(P <0.05),而在治疗后,不停跳组的左心射血分数、6 min步行距离大于停跳组(P <0.05),其NT-pro BNP低于停跳组(P <0.05)。不停跳组的并发症发生率低于停跳组(P <0.05),其死亡率也低于停跳组(P <0.05)。结论采用体外循环不停跳CABG治疗重症冠心病可有效改善患者心功能,促进病情恢复,还可减少并发症,有利于改善预后。
Objective To investigate the clinical efficacy and safety of coronary artery bypass grafting( CABG) on the beating heart with cardiopulmonary bypass( CPB) in the treatment of severe coronary artery disease. Methods From January 2014 to October2017,50 patients with severe coronary heart disease underwent traditional CPB coronary artery bypass grafting or CPB coronary artery bypass grafting on the beating heart were retrospectively studied. The number of graft vessels,CPB time,mechanical ventilation time,the ICU stay,the hospitalization time,cardiac troponin levels,cardiac function indexs,complication incidence and the mortality were compared between the two groups. Results The number of graft vessels in the beating group was less than that in the arrest group( P< 0.05). CPB time,mechanical ventilation time and the duration of ICU stay were shorter than those in the arrest group( P <0.05).After the treatment,the levels of c Tn I and c Tn T in the two groups were significantly lower than those before the treatment( P <0.05).However,the c Tn I and c Tn T in the beating group were lower than those in the arrest group( P <0.05). The 6-minute walking distance and the left ventricular ejection fraction( LVEF) in both groups were significantly higher than those before the treatment( P <0.05),while the N-terminal brain natriuretic peptide precursor( NT-pro BNP) significantly decreased after the treatment( P <0.05). The 6-minute walking distance and the left ventricular ejection fraction in the beating group was higher than those in the arrest group( P <0.05),while its NT-pro BNP was lower( P <0.05). The incidence of complications in the beating group was lower than that in the arrest group( P <0.05),and the mortality was also lower( P < 0. 05). Conclusion Cardiopulmonary bypass coronary artery bypass grafting on the beating heart can effectively improve the heart function,promote the recovery,reduce complications and improve the prognosis of severe coronary artery disease.
Objective To investigate the clinical efficacy and safety of coronary artery bypass grafting( CABG) on the beating heart with cardiopulmonary bypass( CPB) in the treatment of severe coronary artery disease. Methods From January 2014 to October2017,50 patients with severe coronary heart disease underwent traditional CPB coronary artery bypass grafting or CPB coronary artery bypass grafting on the beating heart were retrospectively studied. The number of graft vessels,CPB time,mechanical ventilation time,the ICU stay,the hospitalization time,cardiac troponin levels,cardiac function indexs,complication incidence and the mortality were compared between the two groups. Results The number of graft vessels in the beating group was less than that in the arrest group( P< 0.05). CPB time,mechanical ventilation time and the duration of ICU stay were shorter than those in the arrest group( P <0.05).After the treatment,the levels of c Tn I and c Tn T in the two groups were significantly lower than those before the treatment( P <0.05).However,the c Tn I and c Tn T in the beating group were lower than those in the arrest group( P <0.05). The 6-minute walking distance and the left ventricular ejection fraction( LVEF) in both groups were significantly higher than those before the treatment( P <0.05),while the N-terminal brain natriuretic peptide precursor( NT-pro BNP) significantly decreased after the treatment( P <0.05). The 6-minute walking distance and the left ventricular ejection fraction in the beating group was higher than those in the arrest group( P <0.05),while its NT-pro BNP was lower( P <0.05). The incidence of complications in the beating group was lower than that in the arrest group( P <0.05),and the mortality was also lower( P < 0. 05). Conclusion Cardiopulmonary bypass coronary artery bypass grafting on the beating heart can effectively improve the heart function,promote the recovery,reduce complications and improve the prognosis of severe coronary artery disease.
引文
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[10]陈德祥.体外循环不停跳冠状动脉旁路移植术治疗重症冠心病的临床效果[J].临床合理用药杂志,2017,10(6):140-141.
[11]沈立,杨文钢,黄日太,等.并行循环下不停跳冠状动脉旁路移植术在冠心病患者中的应用[J].中国心血管病研究,2015,13(5):449-452.
[12]Cakir H,Gur O,Ege T,et al.Comparison of the efficacy of the cardiac hypothermia and normothermia to myocardial damage in coronary artery bypass graft surgery with systemic normothermic cardiopulmonary bypass[J].J Cardiovasc Surg,2013,54(3):397-401.
[13]胡佳心,阮新民,林宇,等.停跳与不停跳冠状动脉搭桥术临床结果及短期随访比较分析:附233例报告[J].分子影像学杂志,2015,38(3):200-204.
[14]钟卫权,张阳春,谢兴,等.微创不停跳冠脉搭桥术34例临床分析[J].中外医学研究,2014,12(22):44-45.
[15]孙耀光,佟宏峰,欧阳小康,等.80岁及以上老年冠心病患者非体外循环冠状动脉旁路移植术手术的疗效[J].中华老年医学杂志,2016,35(11):1168-1171.
[16]Erkut B,Dag O,Kaygin MA,et al.On-pump beating-heart versus conventional coronary artery bypass grafting for revascularization in patients with severe left ventricular dysfunction:Early outcomes[J].Can J Surg,2013,56(6):398-404.
[17]Wu YC,Su TW,Zhang JF,et al.Coronary artery bypass grafting versus drug-eluting stents in patients with severe coronary artery disease and diabetes mellitus:systematic review and meta-analysis[J].J Diabetes,2015,7(2):192-201.
[18]肖巍,张健群,赵岩岩,等.体外循环不停跳冠状动脉搭桥在心功能低下患者手术中的应用[J].心肺血管病杂志,2012,31(4):467-470.
[2]Serraino GF,Marsico R,Musolino G,et al.Pulsatile cardiopulmonary bypass with intra-aortic balloon pump improves organ function and reduces endothelial activation[J].Circ J,2012,76(5):1121-1129.
[3]陈德峰,张健,叶海峰,等.左心功能低下患者体外循环心脏不停跳与非体外循环冠脉搭桥的对比研究[J].中国心血管病研究,2013,11(1):16-19.
[4]Drenger B,Fontes ML,Miao Y,et al.Patterns of use of perioperative angiotensin-converting enzyme inhibitors in coronary artery bypass graft surgery with cardiopulmonary bypass:Effects on inhospital morbidity and mortality[J].Circulation,2012,126(3):261-269.
[5]孙阿雨,赵智伟,葛建军,等.急诊不停跳冠状动脉旁路移植术在冠心病介入失败后的应用[J].安徽医科大学学报,2016,51(12):1857-1859.
[6]权晓强,程兆云,孙俊杰,等.并行体外循环下不停跳冠状动脉旁路移植术在冠状动脉左主干病变中的应用价值[J].中华医学杂志,2013,93(32):2545-2548.
[7]陈祥舟,刘梅,肖颖彬,等.体外循环冠状动脉旁路移植术中采用微量晶体停搏灌注法与不停跳法的心肌保护效果比较[J].中国体外循环杂志,2015,13(2):94-98.
[8]蔡巍巍,陈兴澎,王亚宏,等.48例高危冠心病体外循环辅助下不停跳冠状动脉搭桥术的临床分析[J].中国心血管病研究,2013,11(9):657-659.
[9]Petrie MC,Jhund PS,She L,et al.Ten-Year Outcomes After Coronary Artery Bypass Grafting According to Age in Patients With Heart Failure and Left Ventricular Systolic Dysfunction:An Analysis of the Extended Follow-Up of the STICH Trial(Surgical Treatment for Ischemic Heart Failure)[J].Circulation,2016,134(18):1314-1324.
[10]陈德祥.体外循环不停跳冠状动脉旁路移植术治疗重症冠心病的临床效果[J].临床合理用药杂志,2017,10(6):140-141.
[11]沈立,杨文钢,黄日太,等.并行循环下不停跳冠状动脉旁路移植术在冠心病患者中的应用[J].中国心血管病研究,2015,13(5):449-452.
[12]Cakir H,Gur O,Ege T,et al.Comparison of the efficacy of the cardiac hypothermia and normothermia to myocardial damage in coronary artery bypass graft surgery with systemic normothermic cardiopulmonary bypass[J].J Cardiovasc Surg,2013,54(3):397-401.
[13]胡佳心,阮新民,林宇,等.停跳与不停跳冠状动脉搭桥术临床结果及短期随访比较分析:附233例报告[J].分子影像学杂志,2015,38(3):200-204.
[14]钟卫权,张阳春,谢兴,等.微创不停跳冠脉搭桥术34例临床分析[J].中外医学研究,2014,12(22):44-45.
[15]孙耀光,佟宏峰,欧阳小康,等.80岁及以上老年冠心病患者非体外循环冠状动脉旁路移植术手术的疗效[J].中华老年医学杂志,2016,35(11):1168-1171.
[16]Erkut B,Dag O,Kaygin MA,et al.On-pump beating-heart versus conventional coronary artery bypass grafting for revascularization in patients with severe left ventricular dysfunction:Early outcomes[J].Can J Surg,2013,56(6):398-404.
[17]Wu YC,Su TW,Zhang JF,et al.Coronary artery bypass grafting versus drug-eluting stents in patients with severe coronary artery disease and diabetes mellitus:systematic review and meta-analysis[J].J Diabetes,2015,7(2):192-201.
[18]肖巍,张健群,赵岩岩,等.体外循环不停跳冠状动脉搭桥在心功能低下患者手术中的应用[J].心肺血管病杂志,2012,31(4):467-470.