心脏不停跳冠状动脉旁路移植术对冠心病患者脑利钠肽水平的影响

Influence of coronary artery bypass grafting in beating heart on level of brain natriuretic peptide in patients with coronary heart disease

目的探讨心脏不停跳冠状动脉旁路移植术对冠状动脉粥样硬化性心脏病(冠心病)患者脑钠肽水平的影响。方法选取北京安贞医院于2016年5月~2017年5月收治的冠心病患者120例作为研究对象。按手术方式分为研究组62例和对照组58例,对照组采用停跳冠状动脉旁路移植术治疗,研究组采用心脏不停跳冠状动脉旁路移植术治疗,观察两组患者的脑钠肽水平及临床疗效差异。结果研究组治疗总有效率为96.8%,稍高于对照组的89.7%,组间比较差异无统计学意义(P>0.05)。与治疗前比较,治疗后两组心功能指标包括左室射血分数(LVEF)升高、左室舒张末径(LVEDd)及左室收缩末径(LVESd)下降,均有统计学意义(P<0.05)。研究组中LVEF升高、LVEDd、LVESd降低均较对照组显著,差异均有统计学意义(P<0.05)。术前两组患者脑钠肽水平比较,差异无统计学意义(P>0.05),术后6、12、48 h,两组脑钠肽水平持续降低,研究组降低大于对照组(P<0.05)。结论心脏不停跳冠状动脉旁路移植术治疗冠心病疗效确切,有效改善脑钠肽水平,具有临床应用价值。

Objective To investigate the influence of coronary artery bypass grafting(CABG)in beating heart on level of brain natriuretic peptide(BNP)in patients with coronary heart disease(CHD).Methods CHD patients(n=120)were chosen from Beijing Anzhen Hospital from May 2016 to May 2017,and then divided,according to surgical procedures,into study group(n=62)and control group(n=58).The control group was given off-pump CABG,and study group was given CABG in beating heart.The difference in BNP level and clinical efficacy was observed in 2 groups.Results The total effective rate was 96.8%in study group and 89.7%in control group(P>0.05).Compared with before treatment,left ventricular ejection fraction(LVEF)increased,and left ventricular end-diastolic inner diameter(LVEDd)and left ventricular end-systolic diameter(LVESd)decreased in 2 groups after treatment(P<0.05).The increase of LVEF and decreases of LVEDd and LVESd were more significant in study group compare with control group(P<0.05).The difference in BNP level had no statistical significance in 2 groups before treatment(P>0.05),and BNP level decreased continuously in 2 groups after treatment for 6 h,12 h and 48 h,which was more significantly in study group compared with control group(P<0.05).Conclusion CABG in beating heart has definite curative effect on CHD,can effectively improve BNP level,and has clinical application value.