体外与非体外循环冠脉搭桥术心肌损伤和围术期左室收缩功能变化的对比研究.docVIP

体外与非体外循环冠脉搭桥术心肌损伤和围术期左室收缩功能变化的对比研究 　　作者：贡力 陈 鑫 郭子黄 徐明 邱志兵 史宏伟 施乾坤 作者单位:210006南京医科大学附属南京第一医院胸心外科(南京医科大学在职研究生) 　　【摘要】 目的 比较常规体外循环冠状动脉(冠脉)搭桥术(CCABG)和非体外循环冠脉搭桥术(OPCAB)心肌损伤和围术期心脏功能变化。方法 选择50例冠脉搭桥(CABG)病人，其中CCABG组25例，OPCAB组25例。分析血流动力学的动态变化，评价两组围术期心脏功能，并对比两组肌钙蛋白I(cTnI)、内皮素-l(ET-l)的血浆浓度变化。结果 两组术前临床资料无差别。CCABG组术后心排指数(CI)、左室射血分数(LVEF)、面积减少分数(FAC)均较OPCAB组明显降低(P0.05)，CCABG组术后观察期内血浆cTnI、ET-l水平均较OPCAB组明显升高(P0.01)。结论 OPCAB具有良好的心肌保护，术后左室收缩功能优于CCABG，提示OPCAB完全再血管化程度也满意。 　　关键词 冠状动脉搭桥术 心脏功能 内皮素-l 　　Comparative study on myocardial damage and changes of perioperative left ventricle systolic function between CCABG and OPCAB 　　Gong Li，Cheng Xin，Guo Zihuang，et al. 　　The Department of Thoracic and Cardiovascular Surgery，Nanjing The1st Hospital， Affliated to Nanjing Medical University，Nanjing210006. 　　【Abstract】 Objective To compare the myocardial damage and changes of perioperative left ventricle systolic function between conventional on-pump coronary artery bypass grafting(CCABG)and off-pump coronary artery bypass grafting(OPCAB).Methods Fifty partients received CABG(twenty-five in OPCAB group，twenty-five in CCABG group)were enrolled in the study.Transoesophageal echocardiography(TEE)was applied to analyse the changes of periˉoperative left ventricle systolic function in CCABG and OPCAB group，also to compare the concentration changes of troˉponin-I(cTnI)，endothelins-l(ET-l)in plasm in two groups.Results There was no difference regarding the patient racteristics in two groups before surgery.While compared to OPCAB group，the cardiac output index(CI)，the left venˉtricular ejection fraction(LVEF)，fractional area changes(FAC)after surgery respectively in CCABG group decreased reˉmarkably(P0.01).Also，during the observation period，the level of cTnI and ET-l in plasm in CCABG group were much higher than those in OPCAB group(P0.01).Conclusion Compared to CCABG，OPCAB can afford better myˉocardial preservation andperioperative left ventricle systolic function，this means OPCAB