目的 对使用微创体外循环(MECC)于冠状动脉旁路移植(CABG)术中的早期经验及临床结果进行分析.方法 选择2006年8月～2009年10月间在我院接受择期单纯CABG术手术的120例患者,分为微创体外循环组(ME组)、常规体外循环组(CE组)、非体外循环组(OP组)各40例.ME组采用Jostra MECC系统;CE组采用中低温体外循环.收集患者围手术期心肌损伤标志物、脏器功能和血细胞学检查结果进行分析.结果 三组间性别组成、既往病史、术前心功能无统计学差异;三组患者手术时间、移植旁路血管数量无统计学差异.ME组与OP组肌钙蛋白I(cTnI)转后2 h、6 h、12 h均低于CE组(P<0.01).CE组在转后早期谷丙转氨酶(ALT)和总胆红素(TBIL)均高于正常范围,并且ALT在转后2 h、6 h(P<0.05),TBIL在停机、转后2 h(P<0.05)分别显著高于ME组OP组.CE组在转中及围手术期其血浆游离血红蛋白(f-Hb)平均值均高于另外两组.结论 MECC系统应用于所有病例中,没有发生任何技术故障,是安全、可靠的.在CABG术中应用MECC可减轻常规体外循环对组织、血液及肝功能的损伤.%Objective To review the experiences and analyse the clinical outcome in coronary artery bypass grafting operation using minimal extracorporeal circulation ( MECC ). Methods 120 cases accepted coronary artery bypass grafting from Aug. 2006 to Oct. 2009 were divided randomly to minimal extracorporeal circulation group ( ME group ), conventional extracorporeal circulation group ( CE group ) and off - pump group ( OP group ), 40 cases for each group. Record and analysis the general information, clinic data perioperatively, and complications postoperatively for each patient. Results There were no difference in all groups in gender, previous medical history and preoperative cardiac function ( P >0. 05 ) except in the age ( P <0. 05 ). Similarly, there were no differences in operative time, bypass time, ischemic time and graft number in all groups. Contrasted with in CE group, the values of cTNI were lower in ME group and OP group at 2 h, 6 h and 12 h post - ECC ( P <0.01 ). The valves of ALT and TBIL in CE group were higher abnormally at early post - ECC, and significant higher than in ME group and OP group at 2 h, 6 h post - ECC of ALT ( P < 0.05 ), and at termination, 2 h post - ECC of TBIL ( P < 0. 05 ). Conclusion MECC system, used in all cases, are safe and reliable without any technical problems. MECC can reduce the rate of the system organ dysfunction and the incidence of postoperative complications.
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