不停跳和体外循环下冠状动脉搭桥术后患者心肺功能、血液动力学和炎症变化

Effects of beating and cardiopulmonary bypass on cardiopulmonary function,hemodynamics and inflammation after coronary artery bypass grafting

目的探讨不停跳和体外循环下冠状动脉搭桥术后患者心肺功能、血液动力学和炎症变化。方法分析新乡医学院第一附属医院2018年6月到2020年6月行冠脉搭桥术的116例冠心病患者的临床资料,根据循环方式,分为不停跳组(58例)和体外循环组(58例)。不停跳组患者行体外循环不停跳冠状动脉搭桥术治疗,体外循环组患者行体外循环下停跳冠状动脉搭桥术治疗。分析两组患者术后心功能、肺功能、、血液动力学和炎症等指标的变化,计量数据比较采用t检验。结果不停跳组患者手术时间、ICU入住时间和住院时间[(185.65±22.91)min、(2.74±1.037)d和(7.48±2.22)d]明显低于体外循环组手术时间[(223.77±36.97)min、(5.06±1.79)d和(11.67±3.52)d],差异有统计学意义(t=5.036、9.196、13.198,P<0.05)。不停跳组患者心肌酶指标CK-MB和CTnI水平[(26.03±4.81)U/L、(7.86±2.51)μg/L]明显低于体外循环组患者[(43.44±5.85)U/L,(8.81±1.76)μg/L],差异有统计学意义(t=18.971、2.530,P<0.05)。不停跳组患者术毕MVP[(76.88±2.63)mmHg(1 mmHg=0.133 kPa)]明显低于体外循环组患者[(66.99±2.91)mmHg],差异有统计学意义(t=18.971,P<0.05)。不停跳组患者术毕LVSWI[(27.25±1.93)g/(m·m^(2))]明显低于体外循环组患者[(22.62±1.56)g/(m·m^(2))],差异有统计学意义(t=15.399,P<0.05)。不停跳组患者术毕RVSWI[(4.45±1.32)g/(m·m^(2))]明显低于体外循环组患者[(2.97±0.93)g/(m·m^(2))],差异有统计学意义(t=7.470,P<0.05)。不停跳组患者心肌酶指标白细胞介素(IL)-1β和肿瘤坏死因子-α(TNF-α)水平[(49.12±6.53)、(44.96±4.98)pg/ml]明显低于体外循环组患者[(75.36±6.41)、(52.59±7.96)pg/ml],差异有统计学意义(t=23.68、6.703,P<0.05)。不停跳组患者肺顺应性和气道阻力[(447.28±46.87)ml/kPa、(0.63±0.03)kPa/(L·S)]明显低于体外循环组患者肺顺应性和气道阻力[(667.09±39.45)ml/kPa、(0.87±0.05)kPa/(L·S)],差异有统计学意义(t=29.460、35.390,P<0.05)。结论与体外循环下冠脉搭桥术比较,不停跳冠状动脉搭桥术后患者心肺功能恢复快,血液动力学稳定,炎症水平较低。

Objective To investigate the changes of hemodynamics,inflammation and blood gas after coronary artery bypass grafting under beating and cardiopulmonary bypass.Methods The clinical data of 136 patients with coronary heart disease who underwent coronary artery bypass grafting in our hospital from June 2018 to June 2020 were analyzed retrospectively.According to the circulation mode,they were divided into non-stop beating group(68 cases)and cardiopulmonary bypass group(68 cases).The patients in the off-pump group were treated with off-pump coronary artery bypass grafting under cardiopulmonary bypass,and those in the off-pump group were treated with off-pump coronary artery bypass grafting under cardiopulmonary bypass.The changes of cardiac function,pulmonary function,hemodynamics and inflammation were analyzed.Results The operation time,ICU stay time and hospitalization time[(185.65±22.91)min,(2.74±1.037)d and(7.48±2.22)d]in the non-stop beating group were significantly shorter than those in the cardiopulmonary bypass group[(223.77±36.97)min,(5.06±1.79)d and(11.67±3.52)d,t=5.036,9.196,13.198,P<0.05].CK-MB and cTnI levels[(26.03±4.81)U/L and(7.86±2.51)μg/L]were significantly lower in the non-stop beating group than those in the cardiopulmonary bypass group[(43.44±5.85)U/L,(8.81±1.76)μg/L,t=18.971,2.530,P<0.05].The postoperative MVP[(76.88±2.63)mmHg(1 mmHg=0.133 kPa)]in the non-stop beating group was significantly lower than that in the cardiopulmonary bypass group[(66.99±2.91)mmHg,t=18.971,P<0.05].The postoperative LVSWI[(27.25±1.93)g/(m·m^(2))]in the non-stop beating group was significantly smaller than that in the cardiopulmonary bypass group[(22.62±1.56)g/(m·m^(2)),t=15.399,P<0.05].The postoperative RVSWI in the non-stop beating group[(4.45±1.32)g/(m·m^(2))]was significantly smaller than that in the cardiopulmonary bypass group[(2.97±0.93)g/(m·m^(2)),t=7.470,P<0.05].The levels of interleukin(IL)-1βand tumor necrosis factor-α(TNF-α)in the non-stop beating group[(49.12±6.53)and(44.96±4.98)pg/ml]was significantly lower than those in the cardiopulmonary bypass group[(75.36±6.41)and(52.59±7.96)pg/ml,t=23.68,6.703,P<0.05].The lung compliance and airway resistance[(447.28±46.87)and(0.63±0.03)kPa/(L·S)]in the beating group were significantly lower than those in the cardiopulmonary bypass group[(667.09±39.45)and(0.87±0.05)kPa/(L·S),t=29.460,35.390,P<0.05].Conclusion Compared with coronary artery bypass grafting under cardiopulmonary bypass,patients with beating coronary artery bypass grafting have rapid recovery of cardiopulmonary function,stable hemodynamics and low level of inflammation.