冠状动脉旁路移植术中应用磷酸肌酸钠对患者院内预后的影响

Effect of intraoperative phosphocreatine sodium on in-hospital prognosis in patients undergoing coronary artery bypass grafting

目的回顾性分析冠状动脉旁路移植术(CABG)中使用磷酸肌酸钠对患者院内预后的影响。方法收集2012年6月至2012年9月在阜外医院进行单纯CABG的手术736例患者病历资料,手术中使用磷酸肌酸钠600例(P组),未使用磷酸肌酸钠136例(C组)。比较两组患者术中血管活性药的使用情况,术后住院时间,主要心脑血管不良事件及住院死亡率等临床数据。结果 P组患者美国纽约心脏协会(NYHA)心功能分级Ⅲ/Ⅳ级的比例多于C组(P<0.05)。P组术中硝酸甘油和肾上腺素使用率明显少于C组,组间差异有统计学意义(P<0.05)。与C组比较,P组患者术后住院时间明显缩短,组间差异有统计学意义(P<0.05)。两组患者术后主动脉球囊反搏(IABP)使用率,新发房颤、心肌梗死、肾功能衰竭和脑卒中的发生率及院内死亡率差异无统计学意义(P>0.05)。结论术中使用磷酸肌酸钠可减少CABG患者术中血管活性药物的使用,缩短术后住院时间,对患者康复有一定的促进作用,对患者院内心脑血管不良事件的发生率和死亡率没有影响。

Objective To analyze the impact of intraoperative phosphocreatine sodium on in-hospital prognosis in patients undergoing coronary artery bypass grafting（CABG） retrospectively.Methods The medical records of 736 patients receiving CABG were reviewed in Fuwai Hospital from June 2012 to September 2012.Of these patients,600 patients administered phosphocreatine sodium in their surgery（P group） and 136 did not（C group）.The clinical data about the application of vasoactive-inotropic agents in patients during the surgery,the duration of post-operative hospital stay,major adverse cerebral and cardiovascular events and in-hospital mortality were compared between the two groups.Results P group had the higher ratio of NYHA Ⅲ/Ⅳ than C group（P〈0.05）.The usage rates of nitroglycerin and epinephrine in P group were significantly lower than those of C group during the operation（P〈0.05）.Compared with C group,the patients in P group were associated with significant shortened the duration of post-operative hospital stay（P〈0.05）.There were no significant differences in the incidence of postoperative IABP,atrial fibrillation,myocardial infarction,acute renal failure,stroke,or in-hospital mortality between the two groups（P〉0.05）.Conclusion Administration of phosphocreatine sodium can reduce the usage rates of intraoperative vasoactive drugs in patients undergoing CABG,shorten the post-operative hospital stay time,and have a certain role in promoting the recovery of patients.However,it has no effect on the incidence of cardiovascular and cerebrovascular adverse events and in-hospital mortality.