中华医学杂志
中華醫學雜誌
중화의학잡지
National Medical Journal of China
2013年
32期
2545-2548
,共4页
权晓强%程兆云%孙俊杰%赵健%刘晓飞%夏东升%张国报
權曉彊%程兆雲%孫俊傑%趙健%劉曉飛%夏東升%張國報
권효강%정조운%손준걸%조건%류효비%하동승%장국보
冠状动脉疾病%冠状动脉分流术%体外循环%并行体外循环下不停跳冠状动脉旁路移植术%肌钙蛋白Ⅰ
冠狀動脈疾病%冠狀動脈分流術%體外循環%併行體外循環下不停跳冠狀動脈徬路移植術%肌鈣蛋白Ⅰ
관상동맥질병%관상동맥분류술%체외순배%병행체외순배하불정도관상동맥방로이식술%기개단백Ⅰ
Coronary disease%Coronary artery bypass%Extracorporeal circulation%On-pump beating-heart coronary artery bypass grafting%Troponin Ⅰ
目的 评价并行体外循环下不停跳冠状动脉旁路移植术在冠状动脉左主干病变中的应用价值.方法 回顾性分析郑州大学人民医院心外科2009年1月至2012年1月114例接受冠状动脉旁路移植术的冠状动脉左主干病变患者术前及围手术期临床资料,其中48例在传统的体外循环心脏停跳下手术(简称停跳组),另66例在并行体外循环不停跳下手术(简称并循组).结果 术后并循组的临床效果优于停跳组,并循组体外循环时间、呼吸机辅助时间、重症监护病房停留时间、肌钙蛋白恢复时间均短于停跳组,差异均有统计学意义[(89±25)比(117±28) min,(15±14)比(27±19)h,(57±27)比(79±34)h,(6.2±1.8)比(7.0±2.4)d,均p＜0.05].两组血浆肌钙蛋白I在术前差异无统计学意义,但在转机后各时间点比较差异均有统计学意义[并循组比停跳组:转机0.5h:(0.132 ±0.022)比(0.265 ±0.014) μg/L,转机1 h:(0.341 ±0.027)比(0.572±0.046) μg/L,术后1h:(0.641 ±0.036)比(0.932±0.047) μg/L,术后6 h:(1.212 ±0.765)比(1.627 ±0.542) μg/L,术后24 h:(1.496 ±0.263)比(1.734 ±0.328)μg/L,均P＜0.05].结论 并行体外循环下不停跳冠状动脉旁路移植术可以降低冠状动脉左主干病变患者术中风险,减轻心肌损伤,是一种安全、有效的手术方式.
目的 評價併行體外循環下不停跳冠狀動脈徬路移植術在冠狀動脈左主榦病變中的應用價值.方法 迴顧性分析鄭州大學人民醫院心外科2009年1月至2012年1月114例接受冠狀動脈徬路移植術的冠狀動脈左主榦病變患者術前及圍手術期臨床資料,其中48例在傳統的體外循環心髒停跳下手術(簡稱停跳組),另66例在併行體外循環不停跳下手術(簡稱併循組).結果 術後併循組的臨床效果優于停跳組,併循組體外循環時間、呼吸機輔助時間、重癥鑑護病房停留時間、肌鈣蛋白恢複時間均短于停跳組,差異均有統計學意義[(89±25)比(117±28) min,(15±14)比(27±19)h,(57±27)比(79±34)h,(6.2±1.8)比(7.0±2.4)d,均p＜0.05].兩組血漿肌鈣蛋白I在術前差異無統計學意義,但在轉機後各時間點比較差異均有統計學意義[併循組比停跳組:轉機0.5h:(0.132 ±0.022)比(0.265 ±0.014) μg/L,轉機1 h:(0.341 ±0.027)比(0.572±0.046) μg/L,術後1h:(0.641 ±0.036)比(0.932±0.047) μg/L,術後6 h:(1.212 ±0.765)比(1.627 ±0.542) μg/L,術後24 h:(1.496 ±0.263)比(1.734 ±0.328)μg/L,均P＜0.05].結論 併行體外循環下不停跳冠狀動脈徬路移植術可以降低冠狀動脈左主榦病變患者術中風險,減輕心肌損傷,是一種安全、有效的手術方式.
목적 평개병행체외순배하불정도관상동맥방로이식술재관상동맥좌주간병변중적응용개치.방법 회고성분석정주대학인민의원심외과2009년1월지2012년1월114례접수관상동맥방로이식술적관상동맥좌주간병변환자술전급위수술기림상자료,기중48례재전통적체외순배심장정도하수술(간칭정도조),령66례재병행체외순배불정도하수술(간칭병순조).결과 술후병순조적림상효과우우정도조,병순조체외순배시간、호흡궤보조시간、중증감호병방정류시간、기개단백회복시간균단우정도조,차이균유통계학의의[(89±25)비(117±28) min,(15±14)비(27±19)h,(57±27)비(79±34)h,(6.2±1.8)비(7.0±2.4)d,균p＜0.05].량조혈장기개단백I재술전차이무통계학의의,단재전궤후각시간점비교차이균유통계학의의[병순조비정도조:전궤0.5h:(0.132 ±0.022)비(0.265 ±0.014) μg/L,전궤1 h:(0.341 ±0.027)비(0.572±0.046) μg/L,술후1h:(0.641 ±0.036)비(0.932±0.047) μg/L,술후6 h:(1.212 ±0.765)비(1.627 ±0.542) μg/L,술후24 h:(1.496 ±0.263)비(1.734 ±0.328)μg/L,균P＜0.05].결론 병행체외순배하불정도관상동맥방로이식술가이강저관상동맥좌주간병변환자술중풍험,감경심기손상,시일충안전、유효적수술방식.
Objective To explore the value of on-pump beating-heart coronary artery bypass grafting (OnP-BH CABG) for left-main patients with coronary heart disease through a comparative study with conventional coronary artery bypass grafting (CCABG).Methods The clinical data were retrospectively analyzed for 66 patients of OnP-BH and 48 control cases undergoing CCABG from January 2009 to January 2012 at Department of Cardiac Surgery,People's Hospital of Zhengzhou University.Results OnP-BH group had a better clinical outcome than CCABG group.There were obvious statistical difference in cardiopulmonary bypass (CPB) time,mean ventilation time,intensive care unit stay and recovery time of plasma cardiac troponin I (OnP-BH group vs CCABG group:(89 ±25)vs(117 ±28)min,(15 ± 14) vs(27 ± 19)h,(57 ± 27) vs (79 ± 34) h,(6.2 ± 1.8) vs (7.0 ± 2.4) d,all P ＜ 0.05).The data of preoperative cTnI showed no significant difference between two groups(P ＞0.05).However,after CPB,significant intergroup difference existed in the level of cTnI (μg/L) OnP-BH group vs CCABG group:(0.5 h after CPB:(0.132 ± 0.022) vs(0.265±0.014),1 h after CPB:(0.341 ±0.027)vs(0.572 ±0.046),1 h after operation:(0.641 ± 0.036) vs(0.932 ± 0.047),6 h after operation:(1.212 ± 0.765) vs (1.627 ± 0.542) and 24 h after operation:(1.496 ± 0.263) vs (1.734 ± 0.328),all P ＜ 0.05).Conclusions On-pump beating-heart coronary artery bypass grafting is a feasible surgical approach for left-main patients.And it has a low risk and causes less myocardial damage.
