不同冠状动脉旁路移植术式对老年冠心病患者血栓调节蛋白及心肌力学特性的影响

Effects of coronary artery bypass grafting with different operative patterns on thrombomodulin and myocardial mechanical properties in elderly patients with coronary heart disease

目的研究不同冠状动脉旁路移植术式对老年冠心病(CHD)患者血栓调节蛋白(TM)及心肌力学特性(MMP)的影响。方法选取2015年7月~2018年6月入住我院的老年CHD患者128例,依照随机数字表法将其分为OPCABG组(n=64)与CC ABG组(n=64)。OPCABG组行非体外循环冠状动脉旁路移植术(OPCABG)治疗,CCABG组行体外循环冠状动脉旁路移植术(CCABG)治疗。观察两组手术时间、术后1 d引流量、呼吸机辅助时间、桥血管数、血液制品用量、入住ICU时间、住院时间等围术期指标。术前及术后6个月左室舒张末期内径(LVEDD)、左室射血分数(LVEF)等心功能指标。术前、术后7 d血清TM水平,左心室整体面积应变值(GAS)、径向应变值(GRS)、圆周应变值(GCS)、左室整体长轴应变值(GLS)等MMP指标,术后并发症。结果OPCABG组手术时间、术后1 d引流量、呼吸机辅助时间、血液制品用量、入住ICU时间、住院时间等均小于CCABG组(P<0.05)。两组桥血管数比较差异无统计学意义(P>0.05)。术后7 d,OPCABG组GAS、GRS、GLS均高于CCABG组,TM低于CCABG组(P<0.05)。术后7d,两组GCS比较差异均无统计学意义(P>0.05)。OPCABG组围术期并发症发病率低于CCABG组(P<0.05)。术后6个月,两组LVEDD、LVEF比较差异无统计学意义(P>0.05)。结论OPCABG治疗老年CHD创伤小,可减轻血管内皮及心功能损伤,减少生成TM,有助于患者术后恢复,且远期疗效好。

Objective To study the effects of coronary artery bypass grafting(CABG)with different operative patterns on thrombomodulin(TM)and myocardial mechanical properties(MMP)in elderly patients with coronary heart disease(CHD).Methods 128 elderly CHD patients admitted to our hospital from July 2015 to June 2018 were selected.According to the method of random number table,the above 128 elderly CHD patients were divided into OPCABG group(n=64)and CABG group(n=64).OPCABG group was treated with off-pump coronary artery bypass grafting(OPCABG),and CCABG group was treated with off-pump coronary artery bypass grafting(CCABG).The perioperative indexes of the two groups were observed,such as the operation time,the volume of blood products,the time of admission to ICU,the time of hospitalization and so on.Left ventricular end diastolic diameter(LVEDd)and left ventricular ejection fraction(LVEF)were measured before and 6 months after operation.Before and 7 days after operation,the level of serum TM,global area strain(gas),radial strain(GRS),circumferential strain(GCS),global long axis strain(GLS)and other MMP indexes,and postoperative complications.Results The time of operation,the volume of flow,the time of ventilator assistance,the amount of blood products,the time of admission to ICU and the time of hospitalization in OPCABG group were less than those in CCABG group(P<0.05).There was no significant difference in the number of bridging vessels between the two groups(P>005).On the 7 th day after operation,GAS,GRS and GLS in OPCABG group were higher than those in CCABG group,and TM was lower than those in CCABG group(P<0.05).There was no significant difference in GCS between the two groups(P>0.05).The incidence of perioperative complications in OPCABG group was lower than that in CCABG group(P<0.05).There was no significant difference in LVEDd and LVEF between the two groups(P>0.05).Conclusion OPCABG can reduce the injury of vascular endothelial and cardiac function,reduce the generation of TM,and help the patients recover after operation,and has a good longterm effect.