肝素及硝酸甘油静脉持续泵入在冠状动脉旁路移植术前的应用

Application of continuously intravenous introduction of heparin and nitroglycerin with a pump before coronary artery bypass grafting

目的观察冠状动脉旁路移植术前持续静脉泵入肝素及硝酸甘油的疗效及安全性。方法回顾性分析解放军总医院2007年1月-2009年7月于冠状动脉旁路移植术(CABG)前持续静脉泵入肝素及硝酸甘油的62例患者的临床资料,其中非体外循环下CABG(OPCAB)23例,体外循环下CABG(CCABG)39例,另从同期术前未用肝素的患者中随机抽取行OPCAB及CCABG者各40例作为对照组。评价肝素及硝酸甘油对不稳定性心绞痛的缓解效果,并分别比较其在体外循环和非体外循环下对患者输血量、血小板计数及凝血功能等方面的影响。结果术前持续泵入硝酸甘油及肝素能有效缓解不稳定性心绞痛,降低心血管不良事件的发生率。使用及未使用体外循环的患者肝素化前后活化凝血时间及肝素化所用肝素量、输红细胞及血浆量、术后24h引流量、血小板计数及术后凝血功能等方面均无显著差异。结论严重冠脉病变或急性冠脉综合征患者冠状动脉旁路移植术前持续静脉泵入肝素及硝酸甘油安全且效果良好,对手术无明显不利影响。

Objective To evaluate the effectiveness and safety of continuous intravenous pumping of heparin and nitroglycerin before coronary artery bypass grafting （CABG）. Methods The clinical data of 62 patients received continuously intravenous pumping of heparin and nitroglycerin before CABG admitted from Jan. 2007 to Jul. 2009 were analyzed retrospectively. Among them 23 cases underwent off-pump CABG （OPCAB） and 39 cases underwent on-pump CABG （CCABG）. Another 80 cases （40 underwent OPCAB and 40 underwent CCABG） who received operation during the same period but not treated with heparin and nitroglycerin before surgery were enrolled as controls. The effectiveness of heparin and nitroglycerin in relieving unstable angina was investigated,and the influence on transfusion volume,platelet count and coagulation function was compared between OPCAB and CCABG. Results The continuously intravenous pumping of heparin and nitroglycerin before surgery efficiently relieved unstable angina and reduced the incidence of cardiovascular events. No significant differences were observed between OPCAB and CCABG （either before or after operation） in activated clotting time before and after heparinization,the dosage of heparin for heparinization,transfusion volume,24h drainage volume,platelet count and coagulation function. Conclusion The continuous usage of heparin and nitroglycerin before CABG is effective and safe for patients with serious coronary stenosis or acute coronary artery syndrome,and has no obvious adverse effect on operation.