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

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.