非体外循环下冠状动脉搭桥术治疗高龄冠心病三支病变患者的临床观察

来源:用户上传      作者:陈海全 马治欣 李晓燕

　　摘 要 目的：探非体外循环下冠状动脉搭桥术（off-pump coronary artery bypass，OPCAB）治疗高龄冠心病三支病变患者的临床疗效。方法：选取2019年6月―2020年6月河南省平顶山市第二人民医院心脏外科收治的高龄冠心病三支病变患者84例，按随机数字表法分为两组各42例。观察组行OPCAB治疗，对照组行体外循环下冠状动脉搭桥术（conventional coronary artery bypass grafting，CABG）治疗，比较两组手术情况、围手术期心肌和肾损伤指标、手术并发症和随访终点事件。结果：观察组手术用时、术后苏醒时间和住院时间均短于对照组（P<0.05），24 h引流量少于对照组（P<0.05）。术后24 h两组血清肌钙蛋白I（cardiac troponin I，cTnI）、脑钠肽（brain natriuretic petide，BNP）和肌酸激酶同工酶（creatine kinase MB isoenzyme，CKMB）水平均明显高于术前（P<0.05），观察组水平低于对照组（P<0.05）。术后7 d两组血肌酐（serum creatinine，Scr）、尿素氮（blood urea nitrogen，BUN）和胱抑素c（cystatin C，Cys-C）水平均高于术前（P<0.05），观察组水平低于对照组（P<0.05）。随访1年两组切口感染、胸腔积液、房颤、心力衰竭、脑卒中、精神障碍、再次住院和死亡率比较差异均无统计学意义（P>0.05）。结论：OPCAB治疗高龄冠心病三支病变患者能缩短手术时间，减轻心肌损伤和肾损伤，利于术后康复。
　　关键词 冠心病；三支病变；高龄；非体外循环下冠脉搭桥术；体外循环下冠脉搭桥术
　　中图分类号：R541.4 文献标志码：A 文章编号：1006-1533（2022）08-0014-05
　　引用本文 陈海全， 马治欣， 李晓燕. 非体外循环下冠状动脉搭桥术治疗高龄冠心病三支病变患者的临床观察[J]. 上海医药， 2022， 43（8）： 14-18.
　　Clinical observation of off-pump coronary artery bypass grafting in the treatment of elderly patients with three vessel lesions of coronary heart disease
　　CHEN Haiquan1， MA Zhixin1， LI Xiaoyan2（1. Department of Cardiothoracic Surgery， the Second People’s Hospital of Pingdingshan City， Pingdingshan 467000， China； 2. Department of Inpatient Administration， the Second People’s Hospital of Pingdingshan City， Pingdingshan 467000， China）
　　ABSTRACT Objective： To investigate the clinical efficacy of off-pump coronary artery bypass grafting（OPCABG） in the treatment of elderly patients with three vessel lesions of coronary heart disease. Methods： Eighty-four elderly patients with three vessel lesions of coronary heart disease treated in the department of cardiac surgery of the hospital from June 2019 to June 2020 were selected and according to random number table method divided into two groups with 42 patients each. The observation group was treated with OPCABG and the control group were treated with conventional coronary artery bypass grafting（CABG） under cardiopulmonary bypass， and the surgical conditions， perioperative myocardial and renal injury indicators， surgical complications and follow-up end points were compared between the two groups. Results： The operation time， postoperative recovery time and hospital stay in the observation group were shorter than those in the control group（P<0.05）， and the 24-hour drainage volume in the observation group was less than that in the control group（P<0.05）. The levels of serum troponin I， brain natriuretic petide（BNP） and creatine kinase MB isoenzyme（CKMB） were significantly higher in the two groups at 24 hours after surgery than those before（P<0.05）， the level in the observation group was lower than that in the control group（P<0.05）. On the 7th day after operation， the levels of serum creatinine（Scr）， blood urea nitrogen（BUN） and cystatin C（Cys-C） in the two groups were higher than those before operation（P<0.05）. The level in the observation group was lower than that in the control group（P<0.05）. There were no significant differences in incision infection， pleural effusion， atrial fibrillation， heart failure， stroke， mental disorder， re-hospitalization and mortality between the two groups during 1-year follow-up（P>0.05）. Conclusion： OPCABG in the treatment of elderly patients with three-vessel coronary artery disease can shorten the operation time， reduce myocardial damage and kidney damage， and facilitate postoperative recovery.

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