体外循环不停搏下冠脉搭桥手术治疗高危冠心病的临床疗效及对炎性因子的影响

Clinical Efficacy of Coronary Artery Bypass Grafting under Extracorporeal Circulation without Pacing in the Treatment of High-risk Coronary Artery Disease and the Effect on Inflammatory Factors

目的:探讨体外循环不停搏冠脉搭桥术(coronary artery bypass grafting,CABG)治疗冠心病(coronary atherosclerotic heart disease,CAD)的临床疗效。方法:回顾性分析2020年1月—2021年2月焦作市第二人民医院收治的60例CVD高危患者临床资料,根据患者CABG术中心脏状态将其中31例采用不停搏体外循环的患者设为研究组,将另外29例采用停搏体外循环的患者设为对照组。两组患者除心脏停搏/不停搏差异外其余治疗方法均相同。对比两组患者术前1 d与术后3 d的肿瘤坏死因子α (tumor necrosis factor-α,TNF-α)、降钙素原(procalcitonin,PCT)、C反应蛋白(C-reactive protein,CRP)指标,术前与术后1个月的左室射血分数(left ventricular ejection fraction,LVEF)、心肌肌钙蛋白I (cardiac troponin I,c TnI)、心率(heart rate,HR)及术后1个月心血管事件。结果:术前1 d两组PCT、TNF-α、CRP比较,差异无统计学意义(t=0.610、0.546、0.498,P>0.05),术后3 d研究组PCT、TNF-α、CRP低于对照组,差异有统计学意义(t=8.588、9.352、11.028,P<0.05);术前1 d两组患者LVEF、cTnI、HR比较,差异无统计学意义(t=0.270、1.528、0.234,P>0.05),术后1个月研究组LVEF高于对照组,cTnI、HR低于对照组,差异有统计学意义(t=4.450、9.861、5.159,P<0.05);研究组术后1个月心血管事件总发生率12.90%(4/31)低于对照组37.93%(11/29),差异有统计学意义(χ^(2)=5.006,P<0.05)。结论:不停搏体外循环下CABG手术治疗高危CAD患者的安全性较高,可有效减轻CABG手术对患者血管及心肌的损伤,改善术后患者心功能及炎症状态,降低术后心血管事件发生风险。

Objective:To investigate the clinical efficacy of coronary artery bypass grafting(CABG) for the treatment of coronary atherosclerotic heart disease(CAD).Methods:The clinical data of 60 high-risk patients with CVD admitted to our hospital from January 2020 to Ferbury 2021were retrospectively analyzed. The clinical data of 60 high-risk patients with CVD admitted to the hospital from January 2020 to February 2021 were retrospectively analyzed, and 31 of them with non-stop extracorporeal circulation were set as the study group and the other 29 patients with stopped extracorporeal circulation were set as the control group according to the patients’ intraoperative cardiac status of CABG. The treatment was the same in both groups except for the difference in cardiac arrest/non-stop.The tumor necrosis factor-α(TNF-α), procalcitonin(PCT), C-reactive protein(CRP), left ventricular ejection fraction(LVEF), cardiac troponin I(cTnI), heart rate(HR) before and 1 month after surgery and cardiovascular events at 1 month after surgery were compared between the two groups 1 d before and 3 d after surgery.Results:The differences in PCT, TNF-α and CRP between the two groups were not statistically significant 1 d before surgery(t=0.610, 0.546, 0.498, P>0.05). At 3 d postoperatively, PCT, TNF-α, and CRP were lower in the study group than in the control group, with statistically significant differences(t=8.588, 9.352, 11.028, P<0.05). There was no statistically significant difference in LVEF, c TnI, and HR between the two groups 1 d before surgery(t=0.270, 1.528, 0.234, P>0.05). At 1 month postoperatively, LVEF was higher in the study group than in the control group, and c Tn I and HR were lower than in the control group, with no statistically significant differences(t=4.450, 9.861, 5.159, P<0.05). At 1 month postoperatively, the overall incidence of cardiovascular events was 12.90%(4/31) in the study group, which was lower than 37.93%(11/29) in the control group, with a statistically significant difference(χ^(2)=5.006, P<0.05).Conclusion:The safety of CABG surgery under non-stop extracorporeal circulation for high-risk CAD patients is high,which can effectively reduce the damage of CABG surgery to patients’ blood vessels and myocardium, improve postoperative patients’ cardiac function and inflammatory status, and reduce the risk of postoperative cardiovascular events.