冠状动脉旁路移植术患者围手术期使用硝酸异山梨酯与硝酸甘油的疗效及对心功能的影响

Efficacy of isosorbide nitrate and nitroglycerin in the perioperative patients with coronary bypass grafting and their effects on cardiac function

目的探讨冠状动脉旁路移植术患者围手术期使用硝酸异山梨酯与硝酸甘油的疗效及对心功能的影响。方法选择2015年6月至2018年3月我院接诊的冠状动脉旁路移植术患者100例作为研究对象。以随机数表法分为观察组(n=50)和对照组(n=50)。对照组使用硝酸甘油治疗,观察组采用硝酸异山梨酯进行治疗。比较两组疗效、左室舒张末期内径(LVEDD)、左室射血分数(LVEF)、收缩末期内径(LVESD)、肌钙蛋白I(c TnI)及肌酸激酶同工酶(CK-MB)。记录两组患者正常心肌百分比、室壁运动积分及不良反应发生情况。结果观察组临床疗效总有效率94.00%高于对照组的70.00%(P <0.01)。治疗后,两组患者LVEDD、LVESD均较治疗前下降,LVEF较治疗前上升,且观察组LVEDD、LVESD低于对照组(P <0.01),LVEF高于对照组(P <0.01);治疗后,两组患者cTnI、CK-MB水平均较治疗前下降(P <0.05);且观察组cTnI、CK-MB水平均低于对照组(P <0.01);治疗后,观察组正常心肌百分比明显高于对照组,室壁运动积分显著低于对照组(P <0.01);观察组不良反应发生率为12.00%,明显低于对照组的30.00%(P <0.05)。结论在冠状动脉旁路移植术患者围手术期采用硝酸异山梨酯较硝酸甘油效果更加显著,可明显改善心功能、减少不良反应,值得推广与运用。

Objective To investigate the efficacy of isosorbide nitrate and nitroglycerin in the perioperative patients with coronary bypass grafting and their effects on cardiac function. Methods A total of 100 patients with coronary artery bypass grafting, who received treatment in our hospital from June 2015 to March 2018, were selected and randomly divided into the observation group(n=50) and the control group(n=50). The control group was treated with nitroglycerin, and the observation group was treated with isosorbide nitrate. The curative effect, left ventricular end-diastolic diameter(LVEDD), left ventricular ejection fraction(LVEF), end systolic diameter(LVESD), troponin I(cTnI), creatine kinase isoenzyme(CK-MB) in two groups after treatment were compared. The percentage of normal heart muscle, score index of ventricular wall movement and adverse reactions were recorded as well. Results The total effective rate of observation group was 94.00% higher than that of control group’s 70.00%(P<0.01). After treatment, the LVEDD and LVESD in both groups were decreased and LVEF increased. The LVEDD and LVESD in the observation group were significantly lower than that in control group, and the LVEF was significantly higher than in control group(P<0.01). After treatment, cTnI and CK-MB levels in both groups were decreased significantly(P<0.05). The cTnI and CK-MB levels of observation group were lower than those of the control group(P<0.01). After treatment, the percentage of normal heart muscle in observation group was significantly higher than that in control group, and the score index of ventricular wall movement was significantly lower than that in control group(P<0.01). The incidence of adverse reactions in observation group(12.00%) was significantly lower than control group’s 30.00%(P<0.05). Conclusion In the perioperative period of patients undergoing coronary artery bypass grafting, the use of isosorbide nitrate is more effective than nitroglycerin, which can significantly improve cardiac function and reduce adverse reactions.