主动脉内球囊反搏辅助时机对高危非体外循环冠状动脉旁路移植 术患者cTnI 和CK-MB 及病死率的影响
| 作者: |
1蒙革,
1吴伟,
1冯海合,
1石银华,
1李宇,
2杨明华,
3殷珊珊,
4王晓洁
1 石家庄市第一医院/河北医科大学附属人民医院心脏大血管外科，石家庄 050011 2 河北省中医院护理部，石家庄 050011 3 石家庄市第一医院麻醉科，石家庄 050000 4 石家庄市第一医院心内科，石家庄 050000 |
| 通讯: |
蒙革
Email: Wf36891@163.com |
| DOI: | 10.3978/j.issn.2095-6959.2018.09.009 |
摘要
目的：探讨主动脉内球囊反搏(intra-aortic balloon pump，IABP)辅助时机对高危非体外循环冠状动脉旁路移植术(off-pump coronary artery bypass grafting，OPCAB)患者术后肌钙蛋白I(cardiac troponin， cTnI)、肌酸激酶同功酶(creatine kinase isoenzymes，CK-MB)及病死率的影响。方法：回顾性分析 石家庄市第一医院2014年1月至2018年5月高危OPCAB行IABP辅助患者96例，根据IABP辅助时机分为A组(OPCAB前辅助组，n=26)、B组(OPCAB中辅助组，n=39)，C组(OPCAB后辅助组，n=31)。收集3组患者一般临床资料。观察比较3组IABP运转时间、机械通气时间、正性肌力药物辅助时间、ICU滞留时间、术后住院时间、紧急体外循环比例、体外膜肺氧合(extracorporeal membrane oxygenation， ECMO)支持比例、IABP相关并发症发生率及术后1 d，术后2 d cTnI，CK-MB血浆水平及院内、术后30 d病死率。结果：A组左室射血分数<40%比例、左室舒张末期内径、急性心肌梗死比例高于B组和C组(P<0.05)，难治性心绞痛比例低于B组和C组(P<0.05)。A组IABP运转时间、机械通气时间、正性肌力药物辅助时间少于C组(P<0.05)，紧急体外循环、ECMO支持比例少于B组(P<0.05)，术后住院时间少于B组和C组(P<0.05)。A组术后1 d、术后2 d的cTnI，CKMB水平及院内病死率、术后30 d病死率均低于B组和C组(P<0.05)。结论：高危OPCAB患者术前IABP辅助可有效改善围手术期临床指标，降低术后cTnI，CK-MB水平和近期病死率。
关键词：
主动脉内球囊反搏；非体外循环心脏不停跳冠状动脉旁路移植术；辅助时机；肌钙蛋白I；肌酸激酶同功酶；病死率
Influence of auxiliary timing of intra-aortic balloon pump on level of cTNI and CK-MB and mortality in high-risk patients with off-pump coronary artery bypass grafting
CorrespondingAuthor: MONG Ge Email: Wf36891@163.com
DOI: 10.3978/j.issn.2095-6959.2018.09.009
Abstract
Objective: To explore the influences of auxiliary timing of intra-aortic balloon pump (IABP) on cardiac troponin (cTnI), creatine kinase isoenzymes (CK-MB) and mortality rate in high-risk patients with off-pump coronary artery bypass grafting (OPCAB). Methods: The clinic data of 96 high-risk OPCAB patients received IABP in First Hospital of Shijiazhuang from January 2014 to May 2018 were reviewed retrospectively, all patients were divided into group A (IABP implantation before OPCAB, n=26), group B (IABP implantation in OPCAB, n=39) and group C (IABP implantation after OPCAB, n=31). General clinical data were collected in the 3 groups. IABP operation time, mechanical ventilation time, positive muscle force medication assistant time, ICU retention time, postoperative hospitalization time, emergency extracorporeal circulation rate, extracorporeal membrane oxygenation (ECMO) support rate, the incidence of IABP-related complications, plasma levels of cTnI, CK-MB postoperative 1 d and 2 d, nosocomial mortality, and mortality postoperative 30 d were observed and compared in three groups. Results: The proportion of left ventricular ejection fraction <40%, left ventricular end diastolic diameter, the proportion of acute myocardial infarction in group A were higher than those in group B and group C (P<0.05), The proportion of intractable angina pectoris in group A were lower than those in group B and group C (P<0.05). IABP operation time, mechanical ventilation time, positive muscle force medication assistant time in group A were lesser than those in group C (P<0.05), emergency extracorporeal circulation, and ECMO support ratio in group A were lesser than those in group B (P<0.05), postoperative hospitalization time in group A were lesser than those in group B and group C (P<0.05). Plasma levels of cTnI, CK-MB postoperative 1 d and 2 d, nosocomial mortality, and mortality postoperative 30 d in group A were lower than those in group B and group C (P<0.05). Conclusion: Preoperative IABP can effectively improve perioperative clinical indicators and reduce postoperative cTnI, CK-MB levels and recent mortality.
Keywords：
intra-aortic balloon pump; off-pump coronary artery bypass grafting; auxiliary timing; cardiac troponin; creatine kinase isoenzymes; mortality