非体外和体外循环冠状动脉旁路移植术治疗冠心病的临床疗效及其对脑钠肽水平影响的比较研究

A comparative study of clinical efficacy between off-pump and conventional coronary artery bypass grafting in treating the patients with coronary heart disease and its impact on brain natriuretic peptide

目的探讨非体外和体外循环冠状动脉旁路移植术治疗冠心病的临床疗效及其对血浆脑钠肽（BNP）水平的影响。方法选取122例择期行冠状动脉旁路移植术治疗的冠心病患者，按手术方式不同分为体外循环下冠状动脉旁路移植术（CCABG）组（59例）和非体外循环下冠状动脉旁路移植术（OPCABG）组（63例），观察两组手术情况和术后一般临床资料、术后并发症和死亡情况，检测术前、术后即刻、术后6h、术后24h、术后72h、术后1周的血浆BNP水平。结果OPCABG组手术时间、术后呼吸机辅助时间、ICU监护时间、术后24h引流量、术后24h输血量、住院时间分另0为（210．08±60．02）min、（9．01±2．57）h、（32．08±9．17）h、（343．43±98．12）ml、（341．75±97．64）ml、（9．70±2．77）d，均明显低于CCABG组的（309．38±88．39）min、（15．25±4．36）h、（45．14±12．90）h、（530．24±151．50）ml、（752．90±215．11）ml、（15．44±4．41）d，差异有统计学意义（P〈0．05）。OPCABG组术后并发症发生率为15．9％（10／63），明显低于CCABG组的47．5％（28／59），差异有统计学意义（X^2=14．172，P〈0．01）；OPCABG组围手术期病死率为1．6％（1／63），低于CCABG组的8．5％（5／59），但差异无统计学意义（X^2=3．091，P〉0．05）。CCABG组患者术前、术后即刻、术后6h血浆BNP水平分别为（104．54±29．87）、（114．74±32．36）、（129．10±36．15）ng／L，OPCABG组分别为（103．46±29．56）、（109．49±31．28）、（126．42±36．12）ng／L，两组比较差异无统计学意义（P〉0．05）；CCABG组术后24h、术后72h、术后1周血浆BNP水平分别为（335．57±95．83）、（429．98±122．85）、（350．92±100．26）ng／L，明显高于OPCABG组的（241．22±68．92）、（317．49±90．71）、（256．86±73．39）ns／L，差异有统计学意义（P〈0．05），且两组术后血浆BNP水平均高于术前水平，差异有统计学意义（P〈0．05）。结论OPCABG是一种安全、有效的手术方式，并且对患者心功能的维护具有一定优越性。

Objective To investigate the clinical efficacy of off-pump coronary artery bypass grafting （OPCABG） comparing with the conventional coronary artery bypass grafting （CCABG） for treating the patients with coronary heart disease （CHD） and its impact on brain natriuretic peptide （BNP）. Methods One hundred and twenty-two patients undergoing elective coronary artery bypass grafting were divided into CCABG group and OPCABG group according to the surgical method. The operative condition and postoperative clinical data, postoperative complications and death of the two groups were observed. The level of BNP was detected before surgery, immediately after surgery, postoperative 6,24,72 h and 1 week. Results The operative time, postoperative mechanical ventilation time, ICU monitoring time, 24 h after drainage and blood transfusion, hospital stay in OPCABG group was（210.08 ± 60.02） min, （9.01 ± 2.57） h, （32.08 ± 9.17） h, （343.43 ± 98.12） ml, （341.75 ± 97.64） ml, （9.70 ± 2.77） d, significantly lower than those in CCABG group [ （309.38 ± 88.39） min, （ 15.25 ± 4.36） h, （45.14 ± 12.90） h, （530.24 ± 151.50） ml, （752.90 ± 215.11 ） ml, （ 15.44 ± 4.41 ） d ] （P 〈 0.05 ）. The incidence of postoperative complication of OPCABG group and CCABG group was 15.9%（ 10/63 ） and 47.5% （28/59）, there was significant difference （X^2 = 14.172, P 〈 0.01 ）. The mortality rate of OPCABG group and CCABG group was 1.6% （1/63） and 8.5%（5/59 ）, there was no significant difference （ X^2 = 3.091, P 〉 0.05 ）. The level of BNP in CCABG group before surgery, immediately after surgery, postoperative 6 h was （104.54 ± 29.87）, （114.74 ± 32.36）, （ 129.10 ± 36.15 ） ng/L, and in OPCABG group was （ 103.46 ± 29.56 ）, （ 109.49 ± 31.28 ）, （ 126.42 ± 36.12 ） ng/L respectively ,there was no significant difference （P 〉 0.05）. The level of BNP in CCABG group postoperative 24,72 h and 1 week [（335.57 ±95.83）, （429.98 ± 122.85）, （350.92 ± 100.26） ng/L~ were significantly higher than those in OPCABG group [ （241.22 ± 68.92）, （317.49 ± 90.71 ）, （256.86 ± 73.39） ng/L] （P 〈 0.05）. The levels of BNP in both groups postoperative 24,72 h and 1 week were significantly higher than those before surgery （P 〈 0.05 ）. Conclusion The OPCABG surgery is safe and effective, and has certain advantages for maintenance of cardiac function.