不停跳与体外循环下冠状动脉旁路移植术对患者心肌和肾功能影响的对比研究

Comparative study on effects of off-pump coronary artery bypass grafting and extracorporeal circulation coronary artery bypass grafting on myocardial and renal function

目的探讨不停跳下行冠状动脉旁路移植术(CABG)与体外循环下行CABG对患者心肌和肾功能影响。方法将2015年1月至2018年1月间陕西省汉中市中心医院收治的100例冠心病患者随机分为不停跳组(50例)和体外循环组(50例)分别在不停跳下行冠状动脉旁路移植术(OPCABG)与体外循环下冠状动脉旁路移植术(CCABG)。围手术期监测血流动力学指标,并在术后比较两组间心功能、肾功能和并发症发生率。结果两组患者术前情况、手术时间和血管桥数差异无统计学意义(P> 0.05)。不停跳组患者术后心功能指标显著优于体外循环组患者(t=2.370、2.571,P <0.05),不停跳组患者术后2周时,血清中的肿瘤坏死因子(TNF-α)、白细胞介素2(IL-2)和白细胞介素8(IL-8)的水平均明显低于同期体外循环组(t=8.659、17.384、14.373,P <0.05);术后3个月时,两组的炎症因子TNF-α、IL-2和IL-8水平与术前比较差异无统计学意义(t=1.628、0.616、0.750,P> 0.05);不停跳组患者术后肾功能指标显著优于体外循环组患者(t=8.771、3.257,P <0.05)。不停跳组患者低心排量综合征和心房颤动发生率显著低于体外循环组患者(χ2=4.892、 5.324,P <0.05)。结论对改善患者心功能、肾功能、预防相关不良反应的发生OPCABG优于CCABG。

Objective To investigate the effects of off-pump coronary artery bypass grafting(OPCABG)and extracorporeal circulation coronary artery bypass grafting(CCABG)on myocardial and renal function.Methods 100 patients with coronary heart disease in Hanzhong center hospital from Jan 2015 to Jan 2018 were randomly divided into OPCABG group(50 cases)and CCABG group(50 cases),which undergoing OPCABG and CCABG respectively.Hemodynamic parameters were monitored during perioperative period,and cardiac function,renal function and complications were compared between the two groups after operation.Results There was no significant difference in preoperative condition,operation time and number of vascular bridges between the two groups(P>0.05).The indexes of cardiac function in OPCABG group were significantly better than those in CCABG group(t=2.370,2.571;P<0.05).At 2 weeks after operation,the levels of tumor necrosis factor(TNF-α),Interleukin-2(IL-2)and IL-8 in the OPCABG group were significantly lower than those in CCABG group(t=8.659,17.384,14.373;P<0.05).Compared with the levels of inflammatory factors TNF-α,IL-2 and IL-8 of the two groups at 3 months after operation,the levels of TNF-α,IL-2 and IL-8 in two groups before operation had no statistically significant difference(t=1.628,0.616,0.750;P>0.05).The indexes of renal function in OPCABG group were significantly better than those in CCABG group(t=8.771,3.257;P<0.05).The incidences of low cardiac output syndrome and atrial fibrillation in OPCABG group were significantly lower than those in CCABG group(χ2=4.892,5.324;P<0.05).Conclusion OPCABG can improve the cardiac and renal functions of patients and prevent the occurrence of related adverse reactions,which is better than CCABG.