冠脉搭桥合并瓣膜手术中不停跳冠脉搭桥心肌保护技术的应用
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摘要
目的探究冠脉搭桥合并瓣膜手术中不停跳冠脉搭桥心肌保护技术的应用。方法以本院2015年2月至2017年3月来我院心胸外科进行冠脉搭桥合并瓣膜手术的45例患者作为研究对象,所有患者在手术过程中采用不停跳冠脉搭桥心肌保护技术,观察手术前后患者心功能评级、彩超结果对比以及出院情况,对该方法进行评价。结果手术前后对比,左心室射血分数差异无统计学意义(P>0.05);左室舒张末前后径和左房舒张末前后径术后7 d显著低于术前,差异有统计学意义(P<0.05);术后随访3个月发现,Ⅰ级和Ⅱ级心功能显著增加29例,3个月后的心脏功能分级(NYHA)显著优于手术前,差异有统计学意义(P<0.05);术后出现1例纵隔感染和1例切口愈合不佳,经过积极治疗,患者均痊愈出院。结论不停跳心肌保护技术能够在冠脉搭桥合并瓣膜手术中对整体手术过程起到重要的支持,能够保证手术疗效。
Objective To investigate the application of myocardial protection technique in off-pump coronary artery bypass grafting( CABG) combined with valve surgery. Methods Forty-five patients who received CABG combined valve surgery in the cardiothoracic surgery department of our hospital from February 2015 to March 2017 were as the research object. All of the patients were treated by myocardial protection technique in off-pump CABG combined with valve surgery. The preoperative and postoperative heart function rating and color ultra results and surgical patients discharged to evaluate the method. Results There was no difference in left ventricular ejection fraction before and after surgery( P > 0. 05). left ventricular end diastolic diameter and left atrial end diastolic diameter at 7 days after operation was significantly lower than those before operation,the differences were significant( P < 0. 05). After followed up for 3 months,the levelⅠand level Ⅱof cardiac function increased significantly in 29 cases,heart function classification( NYHA) after 3 months was significantly better than that before the surgery,the difference was significant( P < 0. 05). Mediastinal infection occurred in 1 case and poor healing of wound in 1 case,healing after active treatment. Conclusion Myocardial protection technique in off-pump CABG combined with valve surgery plays an important role in the whole surgical process and ensures the operation effect.
Objective To investigate the application of myocardial protection technique in off-pump coronary artery bypass grafting( CABG) combined with valve surgery. Methods Forty-five patients who received CABG combined valve surgery in the cardiothoracic surgery department of our hospital from February 2015 to March 2017 were as the research object. All of the patients were treated by myocardial protection technique in off-pump CABG combined with valve surgery. The preoperative and postoperative heart function rating and color ultra results and surgical patients discharged to evaluate the method. Results There was no difference in left ventricular ejection fraction before and after surgery( P > 0. 05). left ventricular end diastolic diameter and left atrial end diastolic diameter at 7 days after operation was significantly lower than those before operation,the differences were significant( P < 0. 05). After followed up for 3 months,the levelⅠand level Ⅱof cardiac function increased significantly in 29 cases,heart function classification( NYHA) after 3 months was significantly better than that before the surgery,the difference was significant( P < 0. 05). Mediastinal infection occurred in 1 case and poor healing of wound in 1 case,healing after active treatment. Conclusion Myocardial protection technique in off-pump CABG combined with valve surgery plays an important role in the whole surgical process and ensures the operation effect.
引文
[1]楚天舒,葛建军,赵智伟.不停跳冠脉搭桥心肌保护技术在冠脉搭桥合并瓣膜手术中的应用[J].安徽医科大学学报,2016,51(6):897-899.doi:10.19405/j.cnki.issn1000-1492.2016.06.031.
[2]王圣,程兆云,赵子牛,等.顺逆灌结合桥灌技术在重症冠心病搭桥术中的临床应用[J].中国动脉硬化杂志,2015,23(1):87-89.
[3]Nakamura K,Hashimoto K,Okuyama H,et al.Off-pump coro-nary artery bypasssurgery in patients with mitral regurgitation[J].Kyobu Geka,2005,58(12):1057-1062.
[4]艾陈晨,董逸飞,王云.瓣膜病合并冠心病体外循环中的心肌保护[J].中国当代医药,2012,19(9):35-36.doi:10.3969/j.issn.1674-4721.2012.09.016.
[5]卢军魏.非停跳冠脉搭桥对心肌细胞TLR4与mRNA,HSP活性表达的影响及其机制的研究[D].济南:山东大学,2009.
[6]殷恩智,田伟臣,李刚,等.同期行冠状动脉旁路移植和心脏瓣膜置换术治疗冠心病合并心脏瓣膜病的临床研究[J].现代生物医学进展,2014,14(10):1890-1892.
[7]郑理,冠状动脉搭桥术的临床应用[J].安徽医学,2005,26(5):361-363.doi:10.3969./j.issn.1000-0399.2005.05.004
[8]赵敖,胡克检,罗海燕,等.同期实行冠状动脉搭桥和心脏瓣膜手术的体外循环[J].临床医学工程,2007,28(3):155-157.
[9]Eucher PM,Louagie YA,Buche M,et al.Unusual pitfall of useof retrograde cardioplegia[J].Ann Thorac Surg,2009,60:689-690.
[10]Hu Z,Yan Z,Wang H,et al.Comparative analysis of preserva-tion method and intermittent perfusion volume on the expression of endothelial and inflammatory markers by coronal artery and myo-cardium in porcine donor hearts[J].ASAIO J,2014,60(6):681-687.
[11]张明亮,沈玉华,张立敏,等.替格瑞洛对急性ST段抬高型心肌梗死急诊经皮冠状动脉介入患者血小板聚集率及QT离散度的影响[J].中国老年学杂志,2016,36(15):3667-3669.doi:10.3969/j.issn.1005-9202.2016.15.025.
[12]邹行斌,黄鹤.急性STEMI病人在PCI术不同时间应用替罗非班对即刻靶血管造影和心肌损伤的影响[J].中西医结合心脑血管病杂志,2016,14(22):2603-2606.doi:10.3969/j.issn.1672-1349.2016.22.004.
[13]邹勇,刘敏,张苏川.冠脉内注射替罗非班在急性ST段抬高型心肌梗死中的效果观察[J].中国医院药学杂志,2014,34(16):1378-1381.
[14]Liu SQ,Wang YL,Jin Y,et al.Correlation of serum high-sensitivity C-reactiveprotein and interleukin-6 in patients with acute coronary syndrome[J].Genet Mol Res,2014,13(2):4260-4266.
[15]Williams MS,Rogers HL,Ziegelstein RC,et al.Do platelet-derived microparticles play a role in depression,inflammation,and acute coronary syndrome[J].Psychosomatics,2014,55(3):252-260.doi:10.1016/j.psym.2013.09.004.
[16]王立中,俞晓薇,赵冬婧,等.替罗非班联用前列地尔对急诊经皮冠脉介入治疗术后心肌梗死患者心肌再灌注和心功能短期预后的影响[J].中国医药导报,2013,10(17):77-79.doi:10.3969/j.issn.1673-7210.2013.17.027.
[17]陈春望,程勇,张荣林,等.替罗非班联合血栓抽吸对接受经皮冠状动脉介入治疗的急性ST段抬高性心肌梗死患者的梗死相关动脉血流和心功能的影响[J].中国循环杂志,2013,28(8):595-598.doi:10.3969/j.issn.1000-3614.2013.08.010.
[18]郎立国,曲凌光,李振军,等.急性ST段抬高型心肌梗死经皮冠状动脉介入治疗患者预后与平均血小板体积相关性研究[J].中国心血管杂志,2014,19(3):197-199.doi:10.3969/j.issn.1007-5410.2014.03.011.
[19]高鹏,张舸,黄慧贤.尿酸与急性ST段抬高型心肌梗死患者急诊PCI术后冠脉血流及预后的相关性研究[J].医学研究杂志,2015,44(2):104-108.
[20]周鹤,王效增,王耿,等.老年女性急性ST段抬高型心肌梗死患者行急诊PCI的临床特点及冠状动脉病变特点分析[J].中华老年多器官疾病杂志,2016,15(2):98-101.doi:10.11915/j.issn.1671-5403.2016.02.024.
[2]王圣,程兆云,赵子牛,等.顺逆灌结合桥灌技术在重症冠心病搭桥术中的临床应用[J].中国动脉硬化杂志,2015,23(1):87-89.
[3]Nakamura K,Hashimoto K,Okuyama H,et al.Off-pump coro-nary artery bypasssurgery in patients with mitral regurgitation[J].Kyobu Geka,2005,58(12):1057-1062.
[4]艾陈晨,董逸飞,王云.瓣膜病合并冠心病体外循环中的心肌保护[J].中国当代医药,2012,19(9):35-36.doi:10.3969/j.issn.1674-4721.2012.09.016.
[5]卢军魏.非停跳冠脉搭桥对心肌细胞TLR4与mRNA,HSP活性表达的影响及其机制的研究[D].济南:山东大学,2009.
[6]殷恩智,田伟臣,李刚,等.同期行冠状动脉旁路移植和心脏瓣膜置换术治疗冠心病合并心脏瓣膜病的临床研究[J].现代生物医学进展,2014,14(10):1890-1892.
[7]郑理,冠状动脉搭桥术的临床应用[J].安徽医学,2005,26(5):361-363.doi:10.3969./j.issn.1000-0399.2005.05.004
[8]赵敖,胡克检,罗海燕,等.同期实行冠状动脉搭桥和心脏瓣膜手术的体外循环[J].临床医学工程,2007,28(3):155-157.
[9]Eucher PM,Louagie YA,Buche M,et al.Unusual pitfall of useof retrograde cardioplegia[J].Ann Thorac Surg,2009,60:689-690.
[10]Hu Z,Yan Z,Wang H,et al.Comparative analysis of preserva-tion method and intermittent perfusion volume on the expression of endothelial and inflammatory markers by coronal artery and myo-cardium in porcine donor hearts[J].ASAIO J,2014,60(6):681-687.
[11]张明亮,沈玉华,张立敏,等.替格瑞洛对急性ST段抬高型心肌梗死急诊经皮冠状动脉介入患者血小板聚集率及QT离散度的影响[J].中国老年学杂志,2016,36(15):3667-3669.doi:10.3969/j.issn.1005-9202.2016.15.025.
[12]邹行斌,黄鹤.急性STEMI病人在PCI术不同时间应用替罗非班对即刻靶血管造影和心肌损伤的影响[J].中西医结合心脑血管病杂志,2016,14(22):2603-2606.doi:10.3969/j.issn.1672-1349.2016.22.004.
[13]邹勇,刘敏,张苏川.冠脉内注射替罗非班在急性ST段抬高型心肌梗死中的效果观察[J].中国医院药学杂志,2014,34(16):1378-1381.
[14]Liu SQ,Wang YL,Jin Y,et al.Correlation of serum high-sensitivity C-reactiveprotein and interleukin-6 in patients with acute coronary syndrome[J].Genet Mol Res,2014,13(2):4260-4266.
[15]Williams MS,Rogers HL,Ziegelstein RC,et al.Do platelet-derived microparticles play a role in depression,inflammation,and acute coronary syndrome[J].Psychosomatics,2014,55(3):252-260.doi:10.1016/j.psym.2013.09.004.
[16]王立中,俞晓薇,赵冬婧,等.替罗非班联用前列地尔对急诊经皮冠脉介入治疗术后心肌梗死患者心肌再灌注和心功能短期预后的影响[J].中国医药导报,2013,10(17):77-79.doi:10.3969/j.issn.1673-7210.2013.17.027.
[17]陈春望,程勇,张荣林,等.替罗非班联合血栓抽吸对接受经皮冠状动脉介入治疗的急性ST段抬高性心肌梗死患者的梗死相关动脉血流和心功能的影响[J].中国循环杂志,2013,28(8):595-598.doi:10.3969/j.issn.1000-3614.2013.08.010.
[18]郎立国,曲凌光,李振军,等.急性ST段抬高型心肌梗死经皮冠状动脉介入治疗患者预后与平均血小板体积相关性研究[J].中国心血管杂志,2014,19(3):197-199.doi:10.3969/j.issn.1007-5410.2014.03.011.
[19]高鹏,张舸,黄慧贤.尿酸与急性ST段抬高型心肌梗死患者急诊PCI术后冠脉血流及预后的相关性研究[J].医学研究杂志,2015,44(2):104-108.
[20]周鹤,王效增,王耿,等.老年女性急性ST段抬高型心肌梗死患者行急诊PCI的临床特点及冠状动脉病变特点分析[J].中华老年多器官疾病杂志,2016,15(2):98-101.doi:10.11915/j.issn.1671-5403.2016.02.024.