ST段抬高性心肌梗死早期行冠状动脉旁路移植术临床效果

The clinical efficacy analysis of early coronary artery bypass grafting to treat ST-segment elevation myocardial infarction

目的评估早期冠状动脉旁路移植术（CABG）治疗ST段抬高性心肌梗死（STEMI）的临床效果。方法回顾性分析我科2010年9月至2014年12月196例STEMI后2周内行CABG治疗的患者临床资料。按照STEMI发生至外科再血管化的时间间隔窗，将研究对象分成Ⅰ组（≤6h，46例）、Ⅱ组（7～72h，37例）、Ⅲ组（4～7天，52例）和Ⅳ组（8～14天，61例）。分析在不同手术时间窗，患者接受CABG后，围手术期并发症及住院死亡情况，评价STEM1后早期CABG干预的临床效果。结果CABG术后，患者总住院病死率为9．18％（18／196），各组住院病死率分别为10．87％（5／46）、21．62％（8／37）、5．77％（3／52）、3．28％（2／61）。全组中，与生存患者比较，死亡患者多为女性（61．11％对24．16％，P=0．002），多伴有心源性休克（83．33％对24．16％，P〈0．001），血清肌钙蛋白I（cTnI）水平显著升高[（14．1±8．4）ng／ml对（4．7±3．8）ng／ml，P〈0．001]。多元logistics回归分析显示，年龄、女性、血清cTnI水平、肾功能不全和心源性休克是住院死亡的独立危险因素。结论充分的术前管理下，将手术时间窗尽可能移至发病至少3天以后，CABG治疗STEMI的安全性、有效性更高。

Objective To evaluate the clinical efficacy of early coronary artery bypass grafting（CABG） to treat ST-segment elevation myocardial infarction（ STEMI）. Methods We retrospectively analyzed the clinical data of 196 patients within 2 weeks of STEMI attack undergoing CABG in our department from September 2010 to December 2014. According to the time-in- terval between onset of STEMI and the beginning of CABG, all subjects were divided into group Ⅰ （ ≤6 h, n =46 ） , group Ⅱ （7 -72 h, n =37） , groupⅢ （4 -7 d, n =52） and groupⅣ （8 - 14 d, n =61）. After CABG, patients＇ perioperative complications and survival status were analyzed under different surgical time-interval windows to assess the clinical efficacy of early surgical intervention in patients with STEMI. Results Overall in-hospital mortality was 9.18% （18/196）, from group I to group /V, the mortality was 10.87% （5/46）, 21.62% （8/37）, 5.77% （3/52） and 3.28% （2/61）respectively. In all groups, comparing with survivals, nonsurvivals were often women（61.11% vs. 24.16%, P =0. 002）, were more often com- panied by cardiac shock（83.33% vs. 24.16% , P 〈 0. 001 ） , and had higher preoperative cardiac troponin I（cTnI） levels [ （ 14. 1±8.4 ） ng/ml vs. （4.7 ± 3.8 ） ng/ml, P 〈 0.001 ]. Multi-variable logistic regrassion analysis revealed that age, female, cardiac shock, renal insufficiency and serum levels of eTnI were independent risk factors affecting postoperative death. Conclusion Under optimal preoperative management strategies, CABG is relatively feasible and effective with the time-interval window as delay as possible after 3 days of STEMI attack.