非体外循环冠状动脉搭桥术围术期脑氧供需及凝血纤溶系统的变化研究

Study on change of cerebral oxygen supply and demand,coagulation and fibrinolysis system of off-pump coronary artery bypass during perioperative period

目的探讨非体外循环冠状动脉搭桥术围术期脑氧供需及凝血纤溶系统的变化规律。方法选取2009年10月至2012年1月于该院进行非体外循环冠状动脉搭桥术的24例患者为观察组,同期采用体外循环冠状动脉搭桥术进行治疗的24例患者为对照组,比较两组患者肝素化前、术后即刻、术后1、6h的脑氧供需及凝血纤溶系统指标。结果观察组肝素化前、术后即刻、术后1、6h的激活全血凝固时间(ACT)、活化部分凝血酶时间(APTT)、纤维蛋白原(Fig)均高于对照组,CD62p则低于对照组;颈内静脉血氧饱和度(SjvO2)、颈内静脉血氧含量(CjvO2)高于对照组,脑氧摄取率(CERO2)、动脉-颈内静脉血氧含量差(Ca-jO2)低于对照组(P<0.05)。结论非体外循环冠状动脉搭桥术围术期患者的脑氧供需及凝血指标均较好于体外循环冠状动脉搭桥术,其可有效控制出血及降低脑损伤。

Objective To study the variation regularity of cerebral oxygen supply and demand,coagulation and fibrinolysis sys- tem of off-pump coronary artery bypass during perioperative period. Methods 24 patients treated with off-pump coronary artery bypass in our hospital from October 2009 to January 2012 were selected as the observation group,and 24 patients treated with car- diopulmonary bypass coronary artery bypass grafting at the same time were selected as the control group. Then the indexes of cere- bral oxygen supply and demand,coagulation and fibrinolysis system before heparinization,immediately after operation and at post- operative 1,6 h were compared between the two groups. Results ACT, APTT and Fig before heparinization,immediately after op eration and at postoperative 1,6 h in the observation group were higher than those in the control group, CD62p was lower than that in the control group;SjvO2 and CjvO2 were all higher than those in the control group,while CEROz and Ca-jO2 were all lower than those in the control group,all differences between the two groups showing statistical significance（P〈0.05）. Conclusion The cere- bral oxygen supply and demand, coagulation indexes of off-pump coronary artery bypass during perioperative period are all better than those of cardiopulmonary bypass coronary artery bypass grafting. In off-pump coronary artery bypass, bleeding can be effec- tively controlled and the brain injury can be decreased..