不停跳冠脉旁路移植术后心肌酶明显升高的相关因素及早期并发症

Relevant factors and early complications of significantly elevated enzymes after off-pump coronary artery bypass grafting

目的探讨不停跳冠脉旁路移植(OPCABG)术后患者心肌酶明显升高的相关因素及与早期并发症的关系,指导临床上OPCABG患者围手术期处理。方法选取2015年1月至2016年6月行OPCABG手术患者214例,术后测定12、24、48 h肌酸激酶同工酶(CK-MB),将CK-MB≤5.31 ng/m L患者纳入轻度升高组(n=167例),>5.31 ng/m L纳入明显升高组(n=47例)。将两组围手术期临床数据进行统计学对比及Logistic回归分析。结果 Logistic回归分析发现,术前24 h有心绞痛发作、前降支桥位置位于中远或远段、搭桥手术时间是OPCABG术后CK-MB明显升高的相关因素。CK-MB明显升高的患者术后心电图ST段改变、低血压及围手术期心梗(PMI)发病率更高(P<0.05)。结论 OPCABG手术患者,若术前心绞痛发作药物控制不佳,或术中乳内动脉桥搭在前降支的中远或远段,或搭桥手术时间偏长,即使桥血管通畅,术后仍可能会发生心肌酶明显升高、心电图ST段改变、低血压或PMI。

Objective To explore the relevant factors and early complications of significantly elevated enzymes after off-pump coronary artery bypass grafting（ OPCABG）,in order to guide the perioperative management of patients.Methods A total of 214 patients w ho underw ent OPCABG in our hospital during Jan. 2015 and June 2016 w ere enrolled. Postoperative creatine kinase M B（ CK-M B） w as detected at 12 h,24 h and 48 h. Patients w ith CK-M B ≤5. 31 ng/m L w ere classified into group A,and the others w ith CK-M B 5. 31 ng/m L w ere classified into group B. The clinical data of the tw o groups w ere compared and analyzed w ith Logistic regression analysis. Results The relevant factors included occurrence of angina pectoris 24 h before operation,the graft located at the distal or middle-distal segment of left anterior descending artery（ LAD）,and operation time for bypass surgery. Group B had higher incidences of ECG ST segment change,hypotention,and perioperative myocardial infarction（ PM I） than group A（ P〈0. 05）.Conclusions If preoperative angina pectoris is frequent,or the left internal mammary artery is bridged at the distal or middle-distal segment of LAD,or the graft time is too long,early complications such as significantly elevated enzymes,ECG ST segment changes,hypotension,and PM I may occur after OPCABG in patients with graft patency.