预防应用主动脉内球囊反搏在低射血分数患者非体外循环冠状动脉旁路移植术的临床研究
| 作者: |
1屈云飞,
2孙晓宁,
2张红强,
1张俭荣,
1周素明
1 重庆三峡中心医院心脏外科，重庆 404000 2 复旦大学附属中山医院(上海市心血管病研究所)心血管外科，上海 200032 |
| 通讯: |
张俭荣
Email: zhangzhang628@sina.com |
| DOI: | 10.3978/j.issn.2095-6959.2015.07.027 |
摘要
目的：分析预防应用主动脉内球囊反搏(intra-aortic balloon pump，IABP)对术前低射血分数(EF值<40%)的冠心病患者在非体外循环冠状动脉旁路移植术(off-pump coronary artery bypass grafting，OPCAB)中的疗效和预后影响。方法：回顾分析复旦大学附属中山医院心外科2010年1月至2015年1月术前低射血分数的冠心病拟行OPCAB术的患者300例。其中术前预防应用IABP后行OPCAG的患者140例(试验组)，术前未预防应用IABP直接行OPCAB术的患者160例(对照组)。比较二组患者术中被迫紧急改为体外循环下冠状动脉旁路移植术的比例、术后应用体外膜肺氧合(extracorporealmembrane oxygenation，ECMO)的比例、术后低心排及术后肾功能不全的发生率、室性心率失常的发生率、住院期间病死率；比较二组术后气管插管时间、ICU时间及术后住院天数；比较两组术后1、2、5 d血浆肌钙蛋白I(cardiac troponin I，cTnI)、肌酸磷酸激酶同工酶(creatine phosphokinaseisoenzyme，CKMB)水平以及两组术后1年及5年生存率。结果：术中对照组被迫紧急改为体外循环下冠状动脉移植比例高于对试验组(P<0.05)；术后应用ECMO的比例对照组高于试验组(P<0.05)，术后气管插管时间、ICU时间及术后住院天数试验组明显低于对照组(P<0.05)；术后低心排及术后肾功能不全的发生率明显减少(P<0.05)术后1、2 d cTnI及CKMB水平试验组明显低于对照组(P<0.05)，术后5 d cTnI及CKMB水平试验组与对照组相比较无明显差异(P>0.05)；住院期间病死率试验组明显低于对照组(P<0.05)，但术后1年及5年生存率两组无差异(P>0.05)。结论：术前低EF值冠心病预防性应用IABP是安全有效的，能够改善心功能，减少术后心梗、低心排、肾功能不全等严重并发症的发生，从而降低围术期病死率，提高低术前EF值病人OPCAB的手术疗效。
关键词：
低射血分数
主动脉内球囊反搏
非体外循环冠状动脉旁路移植术
冠心病
Prophylactic application of intra-aortic balloon pump for low ejection fraction patients before off-pump coronary artery bypass grafting
CorrespondingAuthor: ZHANG Jianrong Email: zhangzhang628@sina.com
DOI: 10.3978/j.issn.2095-6959.2015.07.027
Abstract
Objective: To analyze clinical and prognosis effect of intra-aortic balloon pump (IABP) application for low ejection fraction (ejection fraction <40%) patients before undergoing off-pump coronary artery bypass grafting (OPCAB). Methods: We retrospectively analyzed clinical data of 300 low ejection fraction patients with coronary artery disease who undergoing OPCAB from January 2010 to January 2015 in Zhongshan Hospital of Fudan University. There were 140 patients underwent IABP implantation before OPCAB in study group (IABP group). We also chose another 160 patients without IABP implantation before undergoing OPCAB as the control group. The ratio of patients undergoing pump coronary artery bypass grafting intraoperative and application of ECOM after operation, postoperative low cardiac output, kidney insufficiency, morbidity, ventricular arrhythmias, trachea cannula time, time of ICU stay and duration of hospital stay, level of troponin I (cTnI) and MB isoenzyme of creatine kinase (CKMB) postoperative 1, 2 and 5 d of two groups were compared. Survival rate was evaluated 1 and 5 years after surgery. Results: The ratio of patients undergoing pump coronary artery bypass grafting intraoperative and application of ECOM after operation is significantly higher than those of the IABP group (P<0.05). Postoperative trachea cannula time, time of ICU stay and duration of hospital stay of the IABP group were significantly shorter than those of the control group (P<0.05). The incidence of low cardiac output, ventricular arrhythmias, kidney insufficiency of the IABP group were significantly lower than those of the control group (P<0.05). The level of cTnI and CKMB postoperative 1 and 2 d were significantly lower than those of the control group (P<0.05), but there was no obviously difference in level of cTnI and CKMB postoperative 5 d between two groups (P>0.05). In-hospital mortality of the IABP group was significantly lower than that of the control group. The differences of survival rate were not statistically significant for 1 and 5 years after surgery between two groups (P>0.05). Conclusion: Preoperative prophylactic IABP application can not only significantly ameliorate patient heart function and reduce perioperative morbidity and mortality, but also considerably reduce surgical risk and improve surgical effect of low ejection fraction patients undergoing OPCAB.