非体外循环冠状动脉旁路移植术前泵入硝酸甘油及肝素对围术期心肌保护作用的观察

The observation of influence of application of continuously intravenous infusion of nitroglycerin and heparin with a pump on myocardial protection before off-pump coronary artery bypass grafting

目的:探讨硝酸甘油及肝素术前持续静脉泵入对非体外循环冠状动脉旁路移植术患者围术期的心肌保护作用。方法:回顾性分析我院2007年2月～2010年4月62例非体外循环冠状动脉旁路移植术(OPCAB)前持续静脉泵入硝酸甘油及肝素患者的临床资料,另外选取同期OPCAB术前未静脉联合应用上述相应药物的患者50例作为对照组。测定两组患者术前、术后6 h、术后第1、3、5天cTnT及CK-MB的水平。同时记录术后主动脉内球囊反搏使用(IABP)和严重心律失常发生率、呼吸机辅助呼吸时间、ICU停留时间、术后住院天数。结果:两组患者术前心肌酶的测定结果均在正常范围,两组术后早期cTnT和CK-MB均有升高,术后6 h、术后第1天,研究组cTnT及CK-MB显著低于对照组(P<0.01)。术后主动脉内球囊反搏使用率(IABP)和严重室性心律失常发生率研究组较对照组低,但差异无统计学意义,两组患者术后机械通气时间、ICU监护时间、术后住院天数差异无统计学意义。结论:术前持续静脉泵入硝酸甘油及肝素治疗使患者平稳的度过围术期且安全有效,具有一定的心肌保护效应。

Objective： To study and research the effects of continuous intravenous application of nitroglycerin and heparin before off-pump coronary artery bypass grafting（OPCAB） on myocardial protection.Methods： There were 62 patients who received continuously intravenous pumping of nitroglycerin and heparin before OPCAB admitted from February 2007 to April 2010 in General Hospital of PLA.Another 50 cases who received OPCAB during the same period but not treated with heparin and nitroglycerin before surgery were enrolled as controls.To evaluate clinical therapeutic effects of the two drugs in relieving unstable angina,CK-MB and cTnT were measured before operation and at 6 h and 1,3,5 days after return to ICU in two groups.The rate of application of the intro-aortic balloon counterpulsation（IABP）,incidence of severe ventricular arrhythmia,time of ICU stay,postoperative hospital day,time of assisted respiration were observed at this time.Results： The levels of cTnI and CK-MB measured before operation in two groups were within the normal range.The levels of CK-MB and cTnT increased after surgery significantly in both groups,the levels of CK-MB and cTnT in the research group were significantly lower than those preoperative values in control group at 6 h and 1 day after operation（P0.01）.The rate of application of IABP and incidence of severe ventricular arrhythmia were lower in research group than in control group,but there were not statistically significant in two groups,time of ICU stay,postoperative hospital day,time of assisted respiration were similar in both groups.Conclusion： Continuous intravenous application of nitroglycerin and heparin before OPCAB was effective and make patients through the perioperative operation.This method has protective effect on the myocardium.