体外循环下冠脉搭桥术患者术后早期心肌损伤及肾损伤的临床分析

Clinical analysis the effect of on-pump coronary artery bypass grafting on myocardial and kidney injury early period of postoperation

目的探讨体外循环下冠脉搭桥术(CABG)患者术后早期心肌损伤及肾损伤情况。方法选取冠心病患者63例,依据手术方式分为对照组(n=31)及观察组(n=32),对照组患者行非体外循环下CABG,观察组患者行体外循环下CABG。分别于手术前后检测并比较两组血清心肌损伤指标及肾损伤指标,另采用彩色多普勒超声诊断仪检测并比较两组手术前后心功能指标。结果与对照组比较,观察组手术时间、住院时间及ICU入住时间均显著延长,24小时引流量显著升高(P<0.05或P<0.01);与术前比较,术毕至术后24小时两组血清肌钙蛋白Ⅰ(cTnⅠ)、肌酸激酶同工酶(CK-MB)水平及心脏指数(CI)均呈先升高后降低趋势,而左心室收缩压(LVSP)、左室做功指数(LVSWI)及右室做功指数(RVSWI)均呈先降低后升高趋势(P<0.05或P<0.01),且对照组cTnⅠ、CK-MB水平显著低于观察组,CI、LVSP、LVSWI及RVSWI均显著高于观察组(P<0.01)。与术前比较,术毕至术后24小时两组血清血尿素氮(BUN)、血肌酐(Scr)、N-乙酰-b-D葡萄糖苷酶(NAG)水平均呈先升高后降低趋势,而Scr清除率则先降低后升高(P<0.05或P<0.01),且术后对照组BUN、Scr、NAG水平显著低于观察组,Scr清除率显著高于观察组(P<0.01)。结论体外循环下CABG较非体外循环下CABG手术时间、住院时间长,且患者术后早期心肌损伤及肾损伤更为严重,临床可优先考虑非体外循环下CABG治疗冠心病。

Objective To explore the effect of on-pump coronary artery bypass grafting （CABG） on myocardial and kidney injury early period of postoperation. Method Total of 63 cases coronary heart disease patients from October 2014 to April 2016 in our hospital were elected and divided into control group（ n = 31 ）and observation group （n = 32） according to modus operandi. Control group treated with off-pump CABG and observation group treated with on- pump CABG. Detected and compared serum myocardial and kidney injury indexes, and detected and compared the cardiac function indexes used the color doppler ultrasonic diagnostic instrument at preoperative and postoperative. Result Compared with control group, the time of operation, hospital stays and ICU extended significantly,24 h led traffic increased significantly（ P〈0. 05 or P〈0. 01 ）. Compared with preoperative, the levels of serum cardiactroponin I （ cTn I ）, Creatine Kinase Isoenzyme-MB （ CK-MB ） and cardiac index （ CI ） in 2 groups were first increased and then decreased ,while the left venteieular systolic pressuer（LVSP） , left ventricular stroke work index （LVSWI）and Right ventricular stroke work index（RVSWI） in 2 groups were first decreased and then increased from the end of op- eration to postoperative 24 h（P〈0.05 or P〈0.01 ）. Besides, thecTn I , CK-MB levels of control group were lower than that of observation group, the CI, LVSP, LVSWI and RVSWI of control group were higher than that of observation group significantly （ P〈0.01 ）. Compared with preoperative, the, blood urea nitrogen （ BUN ）, serum creatinine （Scr） , N-acetyl-β-D-glucosaminidase（NAG） levels in 2 groups were first increased and then decreased, and the Scr clearance rate was first decreased and then increased （P〈O. 05 or P〈0.01 ） , and the BUN, Ser, NAG levels in control group were lower than that in observation group, the Scr clearance rate in control group was higher than that in observation group significantly（ P〈0.01 ）. Conclusion comparing with off-pump CABG ,the operation time and hospital stays of on-pump CABG extend, and the myocardial and kidney injury is more severe, the clinic treatment of coronary heart disease should consider off-pump CABG firstly.