全静脉搭桥与全动脉搭桥对行CABG术后心肌损伤及远期疗效的影响

Effect of total intravenous bypass and total arterial bypass on myocardial injury after CABG operation and its effect on long-term outcome

目的研究全静脉搭桥与全动脉搭桥对行冠状动脉旁路移植术(CABG)的远期疗效及对心肌损伤的影响。方法选取2011年1月至2015年12月在聊城市第二人民医院行CABG的冠状动脉粥样硬化性心脏病(CHD)患者98例为研究对象,以乳内动脉为桥血管的患者为全动脉组(50例),以大隐静脉为桥血管的患者为全静脉组(48例)。比较手术临床指标、术后住院时间、术后并发症、移植血管数量;评价两组远期血管畅通率,分别测定升主动脉阻断时、升主动脉开放后30min,2、4、24h血清糖原磷酸化酶同工酶脑型(GPBB)水平。结果全动脉组平均移植血管数量显著低于全静脉组(P<0.05),全动脉组较全静脉组手术耗时显著增长(P<0.05),阻断升主动脉血流时间显著增长(P<0.05),但术后呼吸机辅助时间显著缩短(P<0.05),心房颤动与切口感染发生率显著降低(P<0.05),两组术后24h胸腔引流量、术后住院时间及其他并发症发生率差异无统计学意义(P>0.05)。术后12个月全动脉组和全静脉组的血管通畅率分别为87.13%、75.97%,全动脉组显著高于全静脉组(P<0.05)。两组血清GPBB水平变化趋势相同,在升主动脉开放后30min到达峰值,随后下降并在24h后恢复至低水平,但全静脉组血清GPBB水平高于全动脉组(P<0.05)。结论全动脉搭桥手术耗时更长,操作难度更大,但术后并发症发生率更低,远期血管通畅率更高,血清GPBB水平更低,对心肌损伤更轻。

Objective To analyze the postoperative long-term effect of total intravenous bypass and total arterial bypass for CABG operation and its effect on myocardial damage.Methods A total of 98 patients with coronary heart disease who underwent CABG surgery in the Second People′s Hospital of Liaocheng City from January 2011 to December 2015 were enrolled.The patients with internal mammary artery as the bridging artery were included in the total arterial group(50 cases).While the patients with venous vessels were the total intravenous group(48 cases).The clinical indexes of the operation,postoperative hospital stay,postoperative complications,and number of graft vessels in the two groups were compared.The patency rate of the two groups were evaluated,and the serum glycogen phosphorylase isoenzyme BB(GPBB)level was detected at the time of ascending aorta blocked and the time that ascending aorta opened for 30 min,2 h,4 h,24 h.Results The average number of graft vessels in the total arterial bypass group was significantly less(P<0.05),and the operation time and ascending aorta block time were longer(P<0.05),but the ventilator assisted time after operation was shorter(P<0.05),incidence rate of atrial fibrillation and incisional infection were lower(P<0.05)when compared with the total intravenous group,but the 24 h thoracic drainage volume,postoperative hospital stay,and other complications rate showed no significant difference between the two groups(P>0.05).The patency rate at 12 months after operation in the total arterial bypass group and total intravenous bypass group was 87.13%,75.97%respectively,the patency rate of the two groups from 2 weeks after operation to 12 months after operation all showed significantly difference(P<0.05).Serum GPBB levels in the two groups showed the same trend.After reaching the peak at 30 min after ascending aorta blocked,then decreased and returned to low level after 24 h,but the serum GPBB level of the total intravenous bypass group was significantly higher(P<0.05).Conclusion The arterial bypass CABG operation need longer operation time,and with more operation difficulty,but the incidence of postoperative complications is lower,the patency rate of the grafts vessels are higher and serum GPBB level is lower,the myocardial injury is lighter when compared with arterial bypass.