多指标评估体外循环与非体外循环冠状动脉旁路移植术心肌损伤的研究

摘要

Objective To comparison of extracorporeal circulation coronary artery bypass grafting (CABG) with off‐pump coronary artery bypass grafting (OPCABG ) the degree of myocardial injury by multi index evaluation .Methods From January 2010 to January 2014 underwent coronary artery bypass graft operation in our hospital were randomly selected for CABG and OP ‐CABG patients ,a total of 60 cases .According to the operation mode for CABG would be recorded as the control group ,OPCABG recorded as observation group ,30 patients in each group ,compared the two groups of anesthesia induced by 5 min after operation (T0 ) ,1 d after operation (T1 ) and 2 d (T2 ) of myocardial troponin I (cTnI) concentration ,creatine kinase isoenzyme (CK‐MB) ac‐tivity ,the concentration of NT‐proBNP and interleukin‐6 (IL‐6) level .And the calculation of myocardial mitochondrial injury ,sta‐tistical comparison of systolic blood pressure (SBP) ,diastolic blood pressure (DBP) and mean arterial pressure (MAP) after 24 h . Results Two groups of patients with cTnI ,CK‐MB ,NT‐proBNP on T0 moment ,any time the level of IL‐6 had no difference(P>0 .05) .In T1 ,T2 moments ,cTnI ,CK‐MB ,NT‐proBNP and IL‐6 were lower than that of the control group (P< 0 .05) .In addition , the observation group in postoperative myocardial mitochondria injury score (1 .90 ± 0 .27) ,significantly lower than the control group (2 .80 ± 0 .31) points ;The observation group ,SBP ,DBP and MAP blood pressure index were higher than the control group , the differences were all statistically significant (P< 0 .05) .Conclusion OPCABG on myocardial injury degree is less than CABG , and the OPCABG postoperative patients recover faster and with higher clinical value .%目的：通过多指标评估对比体外循环冠状动脉旁路移植术（CABG）与非体外循环冠状动脉旁路移植术（OPCABG）心肌损伤程度。方法2010年1月至2014年1月在该院接受冠状动脉旁路移植手术，选取 CABG 和 OPCABG 患者各30例作为研究对象。根据手术方式将行 CABG 记为对照组，行 OPCABG 记为观察组。对比两组手术麻醉诱导5 min 后（T0）、术后1 d （T1）及2 d（T2）的心肌肌钙蛋白 I（cTnI）浓度、肌酸激酶‐同工酶（CK‐MB）活性、氨基酸末端前体脑钠肽（NT‐proBNP）浓度及 IL‐6水平。并计算心肌细胞线粒体损伤，统计对比术后24 h 的收缩压（SBP）、舒张压（DBP）及平均动脉压（MAP）。结果两组患者T0时刻的 cTnI 、CK‐MB 、NT‐proBNP 及任何时刻的 IL‐6水平比较差异无统计学意义（P＞0．05），观察组在 T1、T2时刻的 cTnI 、CK‐MB 、NT‐proBNP 均低于对照组（P＜0．05）。观察组在术后心肌细胞线粒体损伤评分为（1．90±0．27）分，显著低于对照组的（2．80±0．31）分，观察组 SBP 、DBP 及 MAP 等血压指标均高于对照组，差异均有统计学意义（P＜0．05）。结论 OPCABG 术后对心肌损伤程度小于 CABG ，并且 OPCABG 术后患者恢复更快，临床上利用价值更高。