CAJ | 학술논문

目的比较老年患者接受体外循环和非体外循环2种冠状动脉旁路移植(CABG)术式围手术期心脏泵血功能和对心肌影响的程度. 方法 40例65岁以上老年冠心患者分另在offpump[(心脏不停跳组),20例]和on-pump[(心脏停跳组),20例]下行CABG.监测记录术前、术毕、术后第1天晨的心排指数(CI)和体循环阻力指数(SVRI).分别于术前、术毕、术后第1、2、7天晨取静脉血标本,测定心肌肌钙蛋白T(cTNT)和肌酸激酶同工酶(CK-MB)的浓度. 结果术后CI较术前升高,其中心脏不停跳组术毕较心脏停跳组升高更明显[(3.92±0.43)L·min-·m-2比(3.81±0.52)L·min 1·m-2,t=2.036,P＜0.05].术后SVRI较术前降低,组间相同时间点比较差异无统计学意义(P＞0.05).术毕cTNT和CK-MB开始升高,至术后第7天晨恢复正常.其中心脏停跳组术毕CK-MB明显高于心脏不停跳组[(11.8±4.4) μg/L比(8.4±4.3)μg/L,t=2.214,P＜0.05]；术后第1天晨cTNT明显高于心脏不停跳组[(0.23±0.12) μg/L比(0.11±0.09)μg/L,t=2.189,P＜0.05]. 结论心脏不停跳CABG术式比停跳术式更能及时有效改善老年冠心病患者心脏泵血功能,提供更好的心肌保护.
목적 비교노년환자접수체외순배화비체외순배2충관상동맥방로이식(CABG)술식위수술기심장빙혈공능화대심기영향적정도. 방법 40례65세이상노년관심환자분령재offpump[(심장불정도조),20례]화on-pump[(심장정도조),20례]하행CABG.감측기록술전、술필、술후제1천신적심배지수(CI)화체순배조력지수(SVRI).분별우술전、술필、술후제1、2、7천신취정맥혈표본,측정심기기개단백T(cTNT)화기산격매동공매(CK-MB)적농도. 결과 술후CI교술전승고,기중심장불정도조술필교심장정도조승고경명현[(3.92±0.43)L·min-·m-2비(3.81±0.52)L·min 1·m-2,t=2.036,P＜0.05].술후SVRI교술전강저,조간상동시간점비교차이무통계학의의(P＞0.05).술필cTNT화CK-MB개시승고,지술후제7천신회복정상.기중심장정도조술필CK-MB명현고우심장불정도조[(11.8±4.4) μg/L비(8.4±4.3)μg/L,t=2.214,P＜0.05]；술후제1천신cTNT명현고우심장불정도조[(0.23±0.12) μg/L비(0.11±0.09)μg/L,t=2.189,P＜0.05]. 결론 심장불정도CABG술식비정도술식경능급시유효개선노년관심병환자심장빙혈공능,제공경호적심기보호.
Objective To investigate the changes of hemodynamics,cardiac troponin T(cTNT) and CK-MB zymogram perioperatively in elderly patients receiving off-pump versus on-pump coronary artery bypass grafting (CABG).Methods Totally 40 elderly patients (age＞65 years) undergoing surgical revascularization in our hospital were reviewed.20 patients were received off-pump coronary artery bypass grafting (group A),20 patients received on-pump surgery (group B).The cardiac output index (CI) and systemic vascular resistance index (SVRI) of each patient were recorded at the time of preoperative (T1),surgery completion (T2) and first day after surgery (T3).cTNT and CKMB of all patients were detected perioperatively.Results The level of CI was increased after operation,whereas CI of group A in T2 was significantly higher than that of group B [(3.92±0.43) L· min-1 · m-2 & (3.81±0.52)L · min 1 · m-2,t=2.036,P＜0.05).SVRI was decreased after operation,there was no difference between the two groups during the same time (P＞0.05).The levels of cTNT and CK-MB were within normal range before operation,whereas enhanced immediately after operation and returned to normal within the 7th day.The level of CK-MB in group B after operation was higher than that in group A [(11.8±4.4)tμg/L vs.(8.4±4.3)μg/L,t=2.214,P＜0.05) ；The level of cTNT in group B at 1st day after operation was increaesd compared with that in group A [(0.23±0.12)μg/L vs.(0.l1±0.09)μg/L],t=2.189,P＜0.05).Conclusions Both off-pump and on-pump CABG could improve the cardiac output and get approving myocardial protection effects in elderly patients,the effect of off-pump CABG might be superior to that of onpump CABG comparatively.