停跳和不停跳冠状动脉搭桥心肌保护技术对冠脉搭桥合并瓣膜手术患者的疗效分析
|
摘要
目的观察停跳和不停跳冠状动脉搭桥心肌保护技术对冠状动脉搭桥合并瓣膜手术患者的疗效。方法选择2013年9月—2017年12月鄂东医疗集团黄石市中心医院/湖北理工学院附属医院胸心外科行冠状动脉搭桥合并瓣膜手术的患者60例作为研究对象,根据随机数字表法分为2组,每组30例。观察组行不停跳冠状动脉搭桥心肌保护技术,对照组采取停跳体外循环下冠状动脉搭桥术。比较2组患者肌酸激酶同工酶(CK-MB)、心肌肌钙蛋白I(cTnI)、彩色超声结果、术后情况、心功能情况、并发症等,结果术前,2组患者CK-MB水平比较差异无统计学意义(P>0. 05);术后各时点,观察组CK-MB水平均低于对照组(F=9. 074,P=0. 000)。术前,2组患者cTnI水平比较无显著差异(t=1.519,P=0. 134);术后各时点,观察组cTnI水平低于对照组(F=6.403,P=0. 000)。术前,2组患者左心室射血分数(LVEF)、左室舒张末前后径(LVEDD)、左房舒张末前后径(LAEDD)比较无显著差异(P>0.05);术后,观察组LVEDD、LAEDD显著低于对照组(t=2.669、3. 653,P均=0. 001)。观察组的手术时间、ICU留住时间、住院时间、24 h引流量显著少于对照组(t=19. 261、21.894、16.147、20.238,P均=0. 000)。术后3个月,观察组心功能改善程度显著优于对照组(χ~2=17.426,P=0.001)。手术切口愈合不良者1例,术后发生纵隔感染1例。结论冠状动脉搭桥合并瓣膜手术患者行不停跳冠状动脉搭桥心肌保护技术,能有效保护患者心肌功能,临床疗效良好。
Objective To observe the effec-t of myocardial protection techniques for patients undergoing coronary artery bypass grafting(CABG) combined with valvular surgery. Methods From September 2013 to December 2017, 60 patients with coronary artery bypass grafting combined with valvular surgery in thoracic and cardiac surgery of Huangshi Central Hospital(Affiliated Hospital of Hubei Polytechnic College) Affiliated Eastern Hubei Medical Group were selected as the subjects of study. According to the random number table method, there were two groups, 30 cases in each group. The observation group received myocardial protection by off-pump coronary artery bypass grafting, while the control group received coronary artery bypass grafting. The creatine kinase isoenzymes(CK-MB), cardiac troponin I(cTnI), color Doppler ultrasound results,postoperative conditions, cardiac function and complications were compared between the two groups. Results There was no significant difference in CK-MB level between the two groups before operation(P > 0. 05). CK-MB level in the observation group was lower than that in the control group at all time points after operation(F = 9. 074, P =0. 000). There was no significant difference in cTnI level between the two groups before operation(t=1.519, P =0. 134). The level of cTnI in the observation group was lower than that in the control group(F = 6. 403, P = 0. 000). There were no significant differences in left ventricular ejection fraction( LVEF), left ventricular end-diastolic diameter(LVEDD) and left atrial end-diastolic diameter(LAEDD) between the two groups before operation( P > 0.05). After operation, LVEDD and LAEDD in the observation group were significantly lower than those in the control group(t=2. 669. t = 3. 653. P =0. 001). The operation time, ICU retention time, hospitalization time and 24-hour drainage flow in the observation group were significantly less than those in the control group(t=19.261. t=21.894. t = 16. 147, t =20.238, P= 0.000). Three months after operation, the improvement of cardiac function in the observation group was significantly better than that in the control group( χ~2=17. 426, P =0. 001).The incision healing was poor in 1 case and mediastinal infection occurred in 1 case. Conclusion Myocardial protection by off-pump coronary artery bypass grafting can effectively protect myocardial function in patients undergoing coronary artery bypass surgery combined with valvular surgery, and the clinical effect is good.
Objective To observe the effec-t of myocardial protection techniques for patients undergoing coronary artery bypass grafting(CABG) combined with valvular surgery. Methods From September 2013 to December 2017, 60 patients with coronary artery bypass grafting combined with valvular surgery in thoracic and cardiac surgery of Huangshi Central Hospital(Affiliated Hospital of Hubei Polytechnic College) Affiliated Eastern Hubei Medical Group were selected as the subjects of study. According to the random number table method, there were two groups, 30 cases in each group. The observation group received myocardial protection by off-pump coronary artery bypass grafting, while the control group received coronary artery bypass grafting. The creatine kinase isoenzymes(CK-MB), cardiac troponin I(cTnI), color Doppler ultrasound results,postoperative conditions, cardiac function and complications were compared between the two groups. Results There was no significant difference in CK-MB level between the two groups before operation(P > 0. 05). CK-MB level in the observation group was lower than that in the control group at all time points after operation(F = 9. 074, P =0. 000). There was no significant difference in cTnI level between the two groups before operation(t=1.519, P =0. 134). The level of cTnI in the observation group was lower than that in the control group(F = 6. 403, P = 0. 000). There were no significant differences in left ventricular ejection fraction( LVEF), left ventricular end-diastolic diameter(LVEDD) and left atrial end-diastolic diameter(LAEDD) between the two groups before operation( P > 0.05). After operation, LVEDD and LAEDD in the observation group were significantly lower than those in the control group(t=2. 669. t = 3. 653. P =0. 001). The operation time, ICU retention time, hospitalization time and 24-hour drainage flow in the observation group were significantly less than those in the control group(t=19.261. t=21.894. t = 16. 147, t =20.238, P= 0.000). Three months after operation, the improvement of cardiac function in the observation group was significantly better than that in the control group( χ~2=17. 426, P =0. 001).The incision healing was poor in 1 case and mediastinal infection occurred in 1 case. Conclusion Myocardial protection by off-pump coronary artery bypass grafting can effectively protect myocardial function in patients undergoing coronary artery bypass surgery combined with valvular surgery, and the clinical effect is good.
引文
[1]陆国秀,郝珊瑚,王治国,等.联合显像在冠脉搭桥联合干细胞移植治疗心肌梗死疗效评估中的价值[J].中国组织工程研究,2017,21(33);5332-5338. DOI:10. 3969/j. issn. 2095 4344. 2017.33.014.
[2]龙翔,吴永兵,朱书强,等.胸腔镜辅助右侧小切口在二次心脏瓣膜手术中的应用[J].中国老年学杂志,2017,37(14):3547-3548. DOI:10.3969/j. issn. 1005-9202.2017.14.074.
[3]兰蕴平,吴娅秋,黎嘉嘉,等.早期呼吸训练器治疗对冠脉搭桥术后低氧血症患者肺部并发症的影响[J].中国康复理论与实践,2017,23(6):709-713. DOI:10. 3969/j. issn. 1006-9771. 2017.06.019.
[4]石新艳,王虹,刘志梅,等.冠脉搭桥术患者集束化干预措施预防控制呼吸机相关性肺炎效果观察[J].中华医院感染学杂志,2016,26(21):4922-4924. DOI:10. 11816/cn. ni. 2016-161123.
[5]马建赢,李金,杨崛圣,等.一站式杂交技术与非体外循环下冠脉搭桥术治疗复杂冠心病的meta分析[J].中国老年学杂志,2016,36(9):2089-2094. DOI:10. 3969/j. issn. 1005-9202. 2016.09.018.
[6] Taty Zau JF,Costa Zeferino R, Sandrine Mota N, et al. Exercise through a cardiac rehabilitation program attenuates oxidative stress in patients submitted to coronary artery bypass grafting[J]. Redox Report:Communications in Free Radical Research,2018,23(1):94-99. DOI:1080/13510002.2017.1418191.
[7]常新,李红卫,赵根尚.老年心脏瓣膜病合并肺动脉高压患者行瓣膜手术疗效的影响因素[J].中国老年学杂志,2016,36(3):670-672. DOI:10.3969/j. issn. 1005-9202.2016.03.070.
[8] Takakuwa Y,Sarai M,Kawai H,et al. Extracorporeal Shock Wave Therapy for Coronary Artery Disease:Relationship of Symptom Amelioration and Ischemia Improvement[J]. Asia Oceania Journal of Nuclear Medicine&Biology,2018,6(1):1-9. DOI:10. 22038/aojnmb. 2017.9899.
[9]赵嫣红,闻大翔.非体外循环冠脉搭桥患者术后认知功能障碍的相关因素分析[J].上海交通大学学报:医学版,2016,36(1):100-104. DOI:10.3969/j. issn. 1674-8115. 2016.01.020.
[10] Vafaey HR,Salehi Omran MT,Abbaspour S,et al. Anti-coagulation therapy following coronary endarterectomy in patient with coronary artery bypass graft[J]. Caspian Journal of Internal Medicine,2018,9(I):27-31. DOI:10.22088/cjim.9. 1.27.
[11] Bouabdallaoui N,Stevens SR,Doenst T,et al. Impact of intubation time on survival following coronary artery bypass grafting:Insights from the surgical treatment for ischemic heart failure(STICH)trial[J]. Journal of Cardiothoracic and Vascular Anesthesia,2018,32(3):1256-1263. DOI:10. 1161/CIRCULATIONAHA. 116.024800.
[12]曹宏.冠状动脉药物洗脱支架内再狭窄影响因素与防治策略研究进展[J].疑难病杂志,2018, 17(10):1171-1175. DOI:10.3969/j. issn. 1671-6450.2018.10.023.
[13]马志敏,王国宏,陈喆,等.不同剂量氟伐他汀缓释片对冠心病患者PCI术后氧化应激及炎性因子的影响[J].疑难病杂志,2018,17(9):869-872. DOI:10.3969/j. issn. 1671-6450.2018.09.002.
[14]高云,李志忠,林运.经皮冠状动脉介入术后心脏运动康复治疗研究进展[J].中国医药,2018,13(10):1579-1581. DOI:10.3760/j. issn. 1673-4777.2018.10.035.
[15] Safaei N, Babaei H, Azarfarin R, et al. Comparative effect of grape seed extract(vitis vinifera)and ascorbic acid in oxidative stress induced by on-pump coronary artery bypass surgery[J]. Ann Card Anaesth,2017,20(1):45-51. DOI:10.4103/0971-9784.197834
[16]陈秀兰,黄淑田,葛婕丽,等.急性冠状动脉综合征患者出院时血管紧张素转换酶抑制剂及血管紧张素Ⅱ受体拮抗剂的使用情况分析[J].中国医药,2018,13(10):1474-1477.DOI:10.3760/j.issn. 1673-4777.2018.10.009.
[17] Kozlov KL,Bogachev AA. Coronary revascularization in the elderly with stable angina[J]. J Geriatr Cardiol,2015,12(5):555-568.DOI:10. 11909/j. issn. 1671-5411.2015.05.017.
[18]赵科研,尹宗涛,李新民,等.老年瓣膜病合并重度肺动脉高压行瓣膜手术的疗效[J].中国老年学杂志,2015,35(21):6091-6093. DOI:10.3969/j. issn. 1005-9202.2015.21.039.
[19]魏超,庄远,陈麟凤,等.体外循环冠脉搭桥患者围术期输红细胞量的评估及其对术后肺部并发症的影响分析[J].中国实验血液学杂志,2014,22(1):204-208. DOI:10. 7534/j. issn. 1009-2137.2014.01.040.
[20] Cao C,Indraratna P,Doyle M,et al. A systematic review on robotic coronary artery bypass graft surgery[J]. Ann Cardiothorac Surg,2016,5(6):530-543. DOI:10.21037/acs.2016. 11.08.
[21] Raja SG. Myocardial revascularization for the elderly:Current options,role of off-pump coronary artery bypass grafting and outcomes[J]. Curr Cardiol Rev, 2012, 8(1):26-36. DOI:10. 2174/157340312801215809.
[22]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.
[2]龙翔,吴永兵,朱书强,等.胸腔镜辅助右侧小切口在二次心脏瓣膜手术中的应用[J].中国老年学杂志,2017,37(14):3547-3548. DOI:10.3969/j. issn. 1005-9202.2017.14.074.
[3]兰蕴平,吴娅秋,黎嘉嘉,等.早期呼吸训练器治疗对冠脉搭桥术后低氧血症患者肺部并发症的影响[J].中国康复理论与实践,2017,23(6):709-713. DOI:10. 3969/j. issn. 1006-9771. 2017.06.019.
[4]石新艳,王虹,刘志梅,等.冠脉搭桥术患者集束化干预措施预防控制呼吸机相关性肺炎效果观察[J].中华医院感染学杂志,2016,26(21):4922-4924. DOI:10. 11816/cn. ni. 2016-161123.
[5]马建赢,李金,杨崛圣,等.一站式杂交技术与非体外循环下冠脉搭桥术治疗复杂冠心病的meta分析[J].中国老年学杂志,2016,36(9):2089-2094. DOI:10. 3969/j. issn. 1005-9202. 2016.09.018.
[6] Taty Zau JF,Costa Zeferino R, Sandrine Mota N, et al. Exercise through a cardiac rehabilitation program attenuates oxidative stress in patients submitted to coronary artery bypass grafting[J]. Redox Report:Communications in Free Radical Research,2018,23(1):94-99. DOI:1080/13510002.2017.1418191.
[7]常新,李红卫,赵根尚.老年心脏瓣膜病合并肺动脉高压患者行瓣膜手术疗效的影响因素[J].中国老年学杂志,2016,36(3):670-672. DOI:10.3969/j. issn. 1005-9202.2016.03.070.
[8] Takakuwa Y,Sarai M,Kawai H,et al. Extracorporeal Shock Wave Therapy for Coronary Artery Disease:Relationship of Symptom Amelioration and Ischemia Improvement[J]. Asia Oceania Journal of Nuclear Medicine&Biology,2018,6(1):1-9. DOI:10. 22038/aojnmb. 2017.9899.
[9]赵嫣红,闻大翔.非体外循环冠脉搭桥患者术后认知功能障碍的相关因素分析[J].上海交通大学学报:医学版,2016,36(1):100-104. DOI:10.3969/j. issn. 1674-8115. 2016.01.020.
[10] Vafaey HR,Salehi Omran MT,Abbaspour S,et al. Anti-coagulation therapy following coronary endarterectomy in patient with coronary artery bypass graft[J]. Caspian Journal of Internal Medicine,2018,9(I):27-31. DOI:10.22088/cjim.9. 1.27.
[11] Bouabdallaoui N,Stevens SR,Doenst T,et al. Impact of intubation time on survival following coronary artery bypass grafting:Insights from the surgical treatment for ischemic heart failure(STICH)trial[J]. Journal of Cardiothoracic and Vascular Anesthesia,2018,32(3):1256-1263. DOI:10. 1161/CIRCULATIONAHA. 116.024800.
[12]曹宏.冠状动脉药物洗脱支架内再狭窄影响因素与防治策略研究进展[J].疑难病杂志,2018, 17(10):1171-1175. DOI:10.3969/j. issn. 1671-6450.2018.10.023.
[13]马志敏,王国宏,陈喆,等.不同剂量氟伐他汀缓释片对冠心病患者PCI术后氧化应激及炎性因子的影响[J].疑难病杂志,2018,17(9):869-872. DOI:10.3969/j. issn. 1671-6450.2018.09.002.
[14]高云,李志忠,林运.经皮冠状动脉介入术后心脏运动康复治疗研究进展[J].中国医药,2018,13(10):1579-1581. DOI:10.3760/j. issn. 1673-4777.2018.10.035.
[15] Safaei N, Babaei H, Azarfarin R, et al. Comparative effect of grape seed extract(vitis vinifera)and ascorbic acid in oxidative stress induced by on-pump coronary artery bypass surgery[J]. Ann Card Anaesth,2017,20(1):45-51. DOI:10.4103/0971-9784.197834
[16]陈秀兰,黄淑田,葛婕丽,等.急性冠状动脉综合征患者出院时血管紧张素转换酶抑制剂及血管紧张素Ⅱ受体拮抗剂的使用情况分析[J].中国医药,2018,13(10):1474-1477.DOI:10.3760/j.issn. 1673-4777.2018.10.009.
[17] Kozlov KL,Bogachev AA. Coronary revascularization in the elderly with stable angina[J]. J Geriatr Cardiol,2015,12(5):555-568.DOI:10. 11909/j. issn. 1671-5411.2015.05.017.
[18]赵科研,尹宗涛,李新民,等.老年瓣膜病合并重度肺动脉高压行瓣膜手术的疗效[J].中国老年学杂志,2015,35(21):6091-6093. DOI:10.3969/j. issn. 1005-9202.2015.21.039.
[19]魏超,庄远,陈麟凤,等.体外循环冠脉搭桥患者围术期输红细胞量的评估及其对术后肺部并发症的影响分析[J].中国实验血液学杂志,2014,22(1):204-208. DOI:10. 7534/j. issn. 1009-2137.2014.01.040.
[20] Cao C,Indraratna P,Doyle M,et al. A systematic review on robotic coronary artery bypass graft surgery[J]. Ann Cardiothorac Surg,2016,5(6):530-543. DOI:10.21037/acs.2016. 11.08.
[21] Raja SG. Myocardial revascularization for the elderly:Current options,role of off-pump coronary artery bypass grafting and outcomes[J]. Curr Cardiol Rev, 2012, 8(1):26-36. DOI:10. 2174/157340312801215809.
[22]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.