非体外循环冠状动脉搭桥术后心肌梗死的临床特点

Clinical characteristics of postoperative myocardial infarction in patients undergoing off-pump coronary artery bypass grafting

目的探讨非体外循环冠状动脉搭桥术后心肌梗死的临床特点。方法2008年1月至2015年6月在我院行择期非体外循环冠状动脉搭桥手术266例患者，其中22例临床诊断为术后心肌梗死，从其余患者中选择与心肌梗死组一般资料匹配的44例作为对照组，对两组患者的术前资料及术后症状、心电图、cTnI、超声心动图的变化进行比较。结果两组患者术前指标差异均无统计学意义（P均〉0．05）；术后心肌梗死组顽固性胸痛发生率高于对照组[90．9％（20／22）、18．2％（8／44）]，心电图新的病理性Q波发生率高于对照组[27．3％（6／22）、4．5％（2／44）]，S-T段异常发生率高于对照组[95．4％（21／22）、27．3％（12／44）]，两组比较差异均有统计学意义（P均〈0．05）；术后心肌梗死组术后24h内eTnI峰值明显高于对照组[（4．52±2．81）、（0．26±0．22）μg/L），差异有统计学意义（P=0．004）；心肌节段性运动变化发生率差异无统计学意义。结论冠状动脉搭桥术后心肌梗死预测困难；术后心电图、患者主诉对术后心肌梗死的诊断价值大；cTn是非常敏感的指标，但其诊断临床心肌梗死的界值尚需商榷。

Objective To assess the clinical characteristics of postoperative myocardial infarction （PMI） in patients undergoing off-pump coronary artery bypass grafting（OPCAB）. Methods Two hundred and sixty-six patients undertook OPCAB in the Shandong Provincial Chest Hospital from January 2008 to June 2015 were selected, there were 22 cases clinical diagnosis of PMI as PMI group, 44 cases patients whose general information matched MI group were selected as no PMI group. The data of two groups including preoperative records and postoperative symptoms, electrocardiogram （ECG）, cTnI and echocardiography change were compared. Results There were no significant differences about preoperative indexes between the two groups （ P 〉0.05）. Incidences of severe chest pain and new pathological Q-waves and elevated ST segments were significantly higher in PMI group than those in no PMI group （90. 9% （20/22） vs. 18.2% （8/44）, 27. 3% （6/ 22） vs. 4. 5%（2/44） ,95.4%（21/22） vs. 27. 3%（12/44） ） ,the differences were significant（P〈0. 005）. Peak serum levels of cTnI during the first 24 h after operation were significantly higher in patients of PMI group than those in no PMI group, the difference was significant（ （ 4. 52±2. 81 ） μg,/L vs. （ 0. 26±0. 22） μg/L, P = 0.04） . There was no significant difference in the incidence of myocardial segmental motion. Conehmion It is difficult to predict coronary artery bypass grafting after myocardial infarction. It has great value of postoperative ECG, the patient complained in diagnosis of postoperative myocardial infarction. CTn is a very sensitive indicator, but its diagnosis Clinical myocardial infarction boundary value still need to be onen to auestion.