非体外循环下冠状动脉旁路移植术患者心肌酶谱升高的影响因素

Influencing Factors of Elevated Myocardial Enzymes in Patients Undergoing Coronary Artery Bypass Grafting

目的探讨非体外循环不停跳下冠状动脉旁路移植术(OPCABG)患者心肌酶谱升高的影响因素。方法选取在我院完成OPCABG手术患者202例。所有患者术后测定12、24、48h肌酸激酶同工酶(CK-MB),根据CKMB水平分为A组(≤5. 31ng/m L,轻度升高组),B组(> 5. 31ng/m L,明显升高组)。分析不同性别、年龄、吸烟、体质量指数、高血压、2型糖尿病、脑血管疾病、慢性阻塞性肺疾病(COPD)、肾功能不全、陈旧性心肌梗死、既往经皮冠状动脉介入(PCI)史、左主干病变、病变支数、心功能分级等患者术后发生心肌酶升高的差异,再对筛选出的有统计学差异的指标进行多因素回归分析。结果多元回归分析发现,术前有心绞痛发作、前降支桥位置位于中远+远段、平均搭桥手术时间是OPCABG术后CK-MB明显升高的相关因素。结论 OPCABG手术时,应严格控制易引起心肌酶升高的影响因素,以最大程度上降低OPCABG手术对患者心脏的损伤及并发症的发生。

Objective To explore the influence factors of elevated myocardial enzymes in patients undergoing off-pump coronary artery bypass grafting( OPCABG). Methods A total of 202 patients who underwent OPCABG in our hospital were enrolled. Postoperative creatine kinase MB( CK-MB) was detected at 12,24 and 48 h after surgery. Patients with CK-MB ≤5. 31 ng/m L were classified into group A,and the others with CK-MB > 5. 31 ng/m L were classified into group B. The differences of sex,age,smoking,body mass index,hypertension,type 2 diabetes mellitus,cerebrovascular disease,chronic obstructive pulmonary disease( COPD),renal insufficiency,old myocardial infarction,past history of percutaneous coronary intervention( PCI),left main lesion,number of lesion branches and cardiac function classification between the two groups were analyzed. Multivariate regression analysis was used to evaluate the indicators with statistical differences. Results Multivariate regression analysis showed that preoperative angina pectoris attack,anterior descending artery bridge location in the middle and distal segment,and bypass operation time were the related factors of significantly elevated CK-MB after OPCABG. Conclusions The factors that may cause the increase of creatine kinase should be strictly controlled to minimize the damage and complications of the patients with OPCABG.