非体外循环冠状动脉搭桥术的临床疗效研究

Study on clinical curative effect of off-pump coronary artery bypass

目的：探讨研究非体外循环冠状动脉搭桥术（OPCAB）的临床疗效。方法选取符合标准的52例患者并进行OPCAB ，探讨研究使用该手术方法时，患者在术中的生理指标情况、术后患者的心肌酶指标变化情况以及术后患者的心脏功能的变化情况。并选取常规体外循环下冠状动脉搭桥术（cCABG ）组48例作为对照。结果52例患者均手术成功。所有患者进行搭桥1～6支，平均（3．1＆#177;1．7）支；手术时间（1．8～6．7）h，平均手术时间（3．3＆#177;1．5）h。在手术过程中，在吻合回旋支时，患者的血氧分压（PaO2）、心率（HR）和平均血压（MAP）与麻醉前相比，差异有统计学意义（P＜0．05）。在术后1 d ，患者的肌酸激酶、肌酸激酶同工酶与天门冬氨酸氨基转移酶水平均明显高于手术前（P＜0．05），而乳酸脱氢酶与术前相比差异无统计学意义（P＞0．05）。在术后1周，患者肌酸激酶、肌酸激酶同工酶与天门冬氨酸氨基转移酶水平均恢复到正常水平，与术前相比差异无统计学意义（P＞0．05）；而乳酸脱氢酶水平明显高于术前（P＜0．05）。患者在术后3月的射血分数为（47．6＆#177;6．9）％，明显高于术前的（39．1＆#177;5．1）％（P＜0．05）。OPCAB组的ICU治疗时间、辅助呼吸时间、心电监测时间、使用抗生素时间、进食时间、坐起时间与留置引流管时间均明显小于cCABG 组（ P＜0．05）。OPCAB组患者的总并发症发生率明显低于cCABG 组（ P＜0．05）。结论采用OPCAB进行治疗能够很好地降低患者心肌缺血、免疫损伤、再灌注损伤等情况的发生，有效地保护了患者的心脏，促进患者的康复。OPCAB值得在临床上进一步推广使用。

Objective To integrative the clinical curative efficacy of the off‐pump coronary artery bypass （OP‐CAB） .Methods 52 patients conforming to the criteria were chosen to perform OPCAB .The physiological indexes changes during operation ,postoperative myocardial enzyme indexes changes and the postoperative heart function changes were studied and discussed .Results All the 52 patients had successful operation .The number of bypass was 1‐6 ,an average of 3 .1 ＆#177; 1 .7 ;the operation time was （1 .8-6 .7）h ,an average of （3 .3 ＆#177; 1 .5）h .During the operative process ,in the anastomosis of left circumflex ,PaO2 ,HR and MAP had significant changes compared with before an‐esthesia（P〈0 .05） .The levels of creatine kinase（CK） ,creatine kinase isoenzyme（CK‐MB） and aspertate aminotrans‐feranse（AST） on postoperative 1 d were significantly higher than those before operation（P〈0 .05） ,while the level of lactate dehydrogenase（LDH） had no statistically significant difference （P〉 0 .05） .The levels of CK ,CK‐MB and AST at postoperative 1 week were recovered to the normal levels without statistical differences compared with before operation（P〉 0 .05） ,while the LDH level was significantly higher than before operation （P〈 0 .05） .The ejection fraction in postoperative 3 months was（47 .6 ＆#177; 6 .9）% ,which was significantly higher than（39 .1 ＆#177; 5 .1）% before op‐eration（P〈0 .05） .The ICU treatment time ,assisted respiration time ,ECG monitoring time ,antibiotics using time , eating time ,sitting up time and indwelling drainage tube time in the OPCAB group were significantly less than those in the conventional coronary artery bypass grafting （cCABG） group（P〈0 .05） .The total occurrence rate of complica‐tions in the OPCAB group was significantly lower than that in the cCABG group （P〈0 .05） .Conclusion Adopting the OPCAB therapy can better reduce the occurrence of myocardial ischemia ,immune injury and reperfusion injury , effectively protect the patients′heart and promote the recovery .So OPCAB is worthy of further clinical promotion and use .