体外循环及非体外循环冠状动脉旁路移植术后患者急性胃肠功能损伤的对比研究

摘要

目的：比较体外循环及非体外循环冠状动脉旁路移植术后患者急性胃肠功能损伤的发生情况。方法回顾性分析2010年1月—2012年12月南华大学附属第二医院行冠状动脉旁路移植术治疗的冠心病患者536例，根据手术方式分为体外循环组412例，非体外循环组124例。观察两组患者一般情况、基础疾病、超声心动图结果、术后血流动力学、血管活性药物总量、日均尿量，术后急性胃肠功能损伤发生率及急性胃肠功能损伤分级。结果体外循环组与非体外循环组患者性别、年龄、体质量、纽约心脏病学会（ NYHA ）心功能分级、高血压发生率、糖尿病发生率、高脂血症发生率、慢性阻塞性肺疾病发生率、左心室舒张末期内径、左心室射血分数、术后日均心率、日均动脉压、日均中心静脉压、血管活性药物总量（去甲肾上腺素、多巴胺、多巴酚丁胺、肾上腺素）比较，差异均无统计学意义（P＞0.05）；体外循环组患者日均尿量较非体外循环组增多（P＜0.05）。体外循环组22例（5.3％）发生急性胃肠功能损伤，其中Ⅰ级7例、Ⅱ级13例、Ⅲ级1例、Ⅳ级1例；非体外循环组6例（4.8％）发生急性胃肠功能损伤，均为Ⅰ级。两组患者急性胃肠功能损伤发生率比较，差异无统计学意义（χ2＝0.048， P＝0.519）。结论体外循环与非体外循环冠状动脉旁路移植术后患者急性胃肠功能损伤发生率无差异，但非体外循环冠状动脉旁路移植术后均为Ⅰ级。%Objective To compare the incidence of acute gastrointestinal injury ( AGI) after on -pump and off -pump coronary artery bypass surgery .Methods Conducted a retrospective analysis on 536 patients with coronary heart disease who received coronary artery bypass surgery in the Second Hospital Affiliated to South China University from January 2010 to December 2012.According to surgery method, the patients were divided into two groups: on-pump group (n=412) and off-pump group (n=124) .Observed the general condition, basic diseases, echocardiography results, postoperative hemodynamic index, total amount of vascular active drugs , average daily urine output , and the incidence of postoperative AGI and AGI grading.Results The two groups were not significantly different (P>0.05) in gender, age, body weight, New York heart association ( NYHA ) cardiac function classification , prevalence of hypertension , prevalence of diabetes , prevalence of hyperlipidemia , prevalence of chronic obstructive pulmonary disease , left ventricular end -diastolic diameter , left ventricular ejection fraction, postoperative average daily heart rate , average daily arterial pressure , daily central central venous pressure , total vascular active drugs ( norepinephrine , dopamine , dobutamine , adrenaline ); the on -pump group was higher ( P <0.05) than the off-pump group in average daily urine output.AGI occurred in 22 (5.3%) patients in the on -pump group, among which the number of patients at grade Ⅰ, Ⅱ, ⅢandⅣwas 7, 13, 1 and 1 respectively; AGI occurred in 6 (4.8%) patients in the off -pump group , and all of them were at grade Ⅰ.The two groups were not significantly different in the prevalence of AGI (χ2 =0.048, P =0.519 ) .Conclusion No significant difference exists in the incidence of acute gastrointestinal injury between on -pump coronary artery bypass surgery and off -pump coronary artery bypass surgery , while the cases of acute gastrointestinal injury after off -pump coronary artery bypass surgery are all at grade Ⅰ.