体外循环及非体外循环搭桥过程中心肌损伤比较.docVIP

体外循环及非体外循环搭桥过程中心肌损伤比较 　 作者：张海涛，胡盛寿，刘楠，孙寒松，杨九光 ，龙村 【摘要】 目的通过对低温体外循环（on-pump）和常温非体外循环（off-pump ）冠脉搭桥术中及术后心脏损伤临床指标和生化标志物的前瞻性比较，观察两种不同搭桥方法的心脏损伤程度。方法符合条件的冠脉搭桥患者分为on-pump、off-pump 组，就心脏损伤生化标志物：心肌肌钙蛋白I(cTnI)，肌酸磷酸激酶MB（CK－MB），在术前、术毕、术毕4 h、手术开始24 h进行比较，同时在术后24 h内就临床指标（血流动力学、心律失常、ICU的滞留时间等）进行比较。结果临床指标两组无显著统计学差异；生化标志物cTnI 、CK－MB比较：on-pump组在术毕比off－pump组明显升高，并持续到手术开始后的24 h。 结论就敏感的生化标志物cTnI、CK－MB观察，on-pump组的心肌损伤较off－pump组明显，但其早期的临床表现并无显著的差异，说明其损伤仅仅限于生化层面。 【关键词】 冠状动脉搭桥;体外循环;非体外循环;心肌肌钙蛋白;肌酸磷酸激酶 　　Comparison of the Myocardial Injury with On-pump and Off-pump Coronary Artery Bypass Grafting 　　Abstract: OBJECTIVE To systemically compare the degree of myocardial injury between on-pump and off-pump CABG at the early post-operative stage. METHODSAll of the patients for CABG were divided into on-pump and off-pump CABG groups. Items in comparison included cTnI,CK－MB at four points of time between the two groups,and the clinical heart parameters (hemodynamics,arrhythmia et al) and postoperative complications were compared. RESULTSThere were no differences on the clinical parameters and complications between two groups at the early post-operative stage. cTnI and CK－MB were increased more significantly in on-pump group than the off-pump groups from the end of operation to the 24 hours of the beginning of operation. CONCLUSIONThere were no significant differences between the on-pump and off-pump groups on the clinical parameters and complications of the early postoperative stage, but there were significant different at the level of the biochemical markers( cTnI and CK－MB). Patients with on-pump CABG continuously presented higher cTnI and CK－MB than off-pump CABG patients. 　　Key words：CABG;On-pump;Off-pump;cTnI;CK－MB 　　体外循环下（on-pump）冠脉搭桥技术已比较成熟，具有术野静止、无血，便于准确、完全地进行冠脉搭桥，早期及远期效果较好。非体外循环下（off-pump）搭桥手术迅速兴起，无体外循环，避免了低温体外循环的诸多因素，经验丰富的医生可以取得良好的早期效果。本研究拟通过对两种方法术后早期心脏损伤的生化标志物和临床指标的观察，比较两种搭桥方法心脏损伤的情况，以为临床更好的开展工作提供依据。 　　1资料与方法 　　1.1病例选择 　　2003年3～10月间，选择单纯冠状动脉搭桥手术患者，50～70岁之间。on-pump和off-pump病例各33例。病例选择条件：