| 心尖辅助装置在不停跳冠状动脉搭桥术中的应用 |
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| 引用本文： | 黎翠,张军龙,李竞进,孙兆楚.心尖辅助装置在不停跳冠状动脉搭桥术中的应用[J].蚌埠医学院学报,2022,47(11):1539-1542. |
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| 作者姓名： | 黎翠 张军龙 李竞进 孙兆楚 |
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| 作者单位： | 1.南京医科大学康达学院附属连云港市第二人民医院 麻醉科, 江苏 连云港 2220002.南京医科大学第一附属医院 麻醉与围术期医学科, 江苏 南京 210029 |
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| 基金项目： | 江苏省医学会麻醉医学科研专项资金项目SYH-32021-0038 |
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| 摘 要： | 目的探讨心尖吸引装置在不停跳冠状动脉搭桥术（OPCABG）中的应用效果。方法选择冠状动脉造影确诊为多支冠脉病变，拟行OPCABG病人80例，随机将病人分为心尖吸引组和对照组，各40例。心尖吸引组利用心尖吸引器辅助行冠状动脉搭桥术，对照组采用常规心脏暴露法。记录2组病人手术开始时（T0）、冠脉搭桥前（T1）、改变心脏位置时（T2）、心脏放回心包腔内时（T3），各时间点的平均动脉压、心率、中心静脉压及肺动脉楔压。记录术前及术后24 h心肌标志物肌钙蛋白I（cTnI）、肌钙蛋白T（cTnT）和N端脑钠肽前体（NT-ProBNP）水平、搭桥和手术时间、吻合一次成功率、搭桥期间去甲肾上腺素的用量、心律失常的发生率、术中出血量以及术后并发症等情况。结果侧壁及下壁靶血管吻合时，心尖吸引组病人血流动力学更稳定、心律失常发生率低、去甲肾上腺素用量少（P < 0.01）；且术中靶血管显露良好、出血少、搭桥时间短（P < 0.01）。术后24 h 2组病人心功能指标均升高（P < 0.01），且心尖吸引组病人cTnT和NT-ProBNP低于对照组（P < 0.05），机械通气时间及ICU住院时间更短，且不良反应发生率低（P < 0.05~P < 0.01）。结论在不停跳冠状动脉搭桥手术中使用心尖吸引装置，有利于靶血管暴露和精准吻合，改善术中病人血流动力学及术后心功能。
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| 关 键 词： | 冠心病 冠状动脉搭桥术 心尖吸引 心肌标志物 N末端脑钠肽前体 |
| 收稿时间： | 2022-02-25 |
Application effects of cardiac positioner device in off-pump coronary artery bypass grafting |
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| Affiliation: | 1.Department of Anesthesiology, The Second People's Hospital of Lianyungang of Nanjing Medical University Kangda College, Lianyungang Jiangsu 2220002.Department of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing Jiangsu 210029, China |
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| Abstract: | ObjectiveTo investigate the effects of cardiac positioner device in off-pump coronary artery bypass grafting.MethodsA total of 80 patients with multi-vessel coronary artery disease diagnosed by angiography were randomly divided into the cardiac positioner group and control group(40 cases in each group).The apical aspirator was used to assist the coronary artery bypass grafting in the apical aspirator group, while the conventional cardiac exposure was used in the control group.The mean arterial pressure, heart rate, central venous pressure and pulmonary artery wedge pressure in two groups were recorded at the beginning of surgery(T0), before coronary artery bypass(T1), when the heart position was changed(T2) and when the heart was placed back into the pericardial cavity(T3).The levels of the cardiac markers troponin I(cTnI), troponin T(cTnT) and N-terminal pro-brain natriuretic peptide(NT-probNP), time of bypass and operation, success rate of one anastomosis, amount of norepinephrine during bypass, incidence of arrhythmia, bleeding volume during operation, amount of intraoperative and postoperative complications in two groups were recorded before operation and after 24 h of operation.ResultsWhen the target vessel in the lateral wall and inferior wall in the cardiac positioner group were anastomosed, the hemodynamics was more stable, the arrhythmia was lower incidence and the dosage of norepinephrine was less(P < 0.01), and the target vessels were well exposed, the bleeding was less and the bypass time was short(P < 0.01).At 24 h after operation, the cardiac function indexes of two groups increased(P < 0.01), and the cTnT and NT-probNP in apical suction group were lower than those in control group(P < 0.05).Compared with the control group, the mechanical ventilation time and ICU stay time were shorter, and the incidence rate of adverse reactions was lower in the cardiac positioner group(P < 0.05 to P < 0.01).ConclusionsThe application of apical positioner device in off-pump coronary artery bypass grafting is beneficial to the exposure and accurate anastomosis of target vessels, and can improve the intraoperative hemodynamics and postoperative cardiac function. |
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