目的:比较在非体外循环冠状动脉旁路移植术(OPCAB)围术期不同时机应用主动脉内球囊反搏的临床效果.方法:回顾分析OPCAB围术期应用主动脉球囊反搏(IABP)的患者80例,其中术前应用组20例,术中应用组31例,术后组29例.比较三组患者术中被迫紧急建立心肺转流(CPB)转为体外循环下冠状动脉旁路移植术(ONCAB)的比例,术后应用体外膜肺氧合(ECMO)的比例、住院期间病死率；以及三组IABP反搏时间、气管插管时间、ICU时间及术后住院天数.观察术后1d、术后2d血浆肌钙蛋白I(cTnI)、肌酸磷酸激酶同工酶(CKMB)水平.结果:术中应用组被迫紧急建立体外循环改为ONCAB比例高于术前应用组；IABP反搏时间、气管插管时间,术前应用组少于术后组；术前应用组的术后住院天数少于其他两组.术后组术后2d cTnI高于术前应用组；术后1d、2d CKMB水平,术前应用组也明显低于另外两组.结论:危重患者OPCAB术前应用IABP可以改善围术期的管理,提高救治成功率.%Objective: Clinical outcomes of patients who received intra-aortic balloon pump support at different time during off-pump coronary artery bypass grafting ( OPCAB) were compared in this study. Methods; The analysis included 20 cases of preoprative IABP, 31 cases of intra-operative IABP and 29 cases of postoperative IABP underwent OPCAB. The rate of conversion to CPB, ECMO, in-hospital mortality, and time of IABP, intubation and ICU stay length, postoperative hospital days were summarized. Plasma levels of cardiac Troponin I (cTnI) and Creatine kinase MB (CK-MB) were measured perioperatively. Results; The preoprative group had lower rate of conversion to CPB and less time of IABP, less time of incubation and postoperative hospital days. Preoprative group also had lower cTnI and CKMB values compared to the other two groups. Conclusion; Evidence suggests that preoprative use of IABP may improve the peri-operative management of high risk patients undergoing coronary artery bypass grafting.
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