冠心病合并慢性阻塞性肺疾病患者冠状动脉旁路移植术疗效分析

目的 评价冠心病合并慢性阻塞性肺疾病（COPD）患者行冠状动脉旁路移植术（CABG）的临床效果。方法 回顾性分析我院1998年1月～2004年12月27例冠心病合并COPD患者接受CABG的临床资料，根据术中采用不同的方法分为非体外循环CABG组（off—pump组，18例）和体外循环CABG组（on—pump组，9例），并在不同时间点对两组患者的氧合指数（PaO2／FiO2）、呼吸功能相关指标、细胞间黏附分子1（ICAM-1）的变化及肺泡灌洗液中中性粒细胞数量进行比较分析。结果 两组患者均无手术死亡；术后14d off—pump组死亡1例，死于呼吸衰竭；on—pump组发生呼吸系统并发症较off—pump组多。体外循环（CPB）30min后／手术开始on—pump组患者的PaO2／FiO2高于off—pump组，而在术后6h和12h却明显低于off—pump组（P〈0．05）；手术开始／CPB30min到术后24h血浆中ICAM-1的浓度off—pump组均低于on—pump组（P〈0．05）；肺泡灌洗液中中性粒细胞数on—pump组均高于off—pump组（P〈0．05）。结论 Off—pump CABG对肺的气体交换功能损伤较小，术后肺部并发症发生率较低，因此更适合于冠心病合并COPD的患者。

Outcome of Coronary Artery Bypass Grafting on Patients of Coronary Artery Disease Complicated with Chronic Obstructive Pulmonary Disease

Objective To evaluate the clinic outcomes of coronary artery bypass grafting(CABG) on patients of coronary artery disease complicated with chronic obstructive pulmonary disease(COPD).Methods The data of 27 patients of coronary artery diseases complicated with COPD who had received CABG from Jan.1998 to Dec.2004,were retrospectively summarized. 18 patients received off-pump CABG(off-pump group),and 9 cases received on-pump CABG(on-pump group).All patients accepted the evaluation about clinical respiratory complications,oxygenation index(PaO_2/FiO_2),related respiratory function index,plasma intercellular adhesion molecule 1((ICAM-1)) and the amount of neutrophil in pulmono-alveolar perfusion fluid at the different time point including the start of CPB(for off-pump group,the measurement accepted at the start of operation),end of CPB(end of operation for off-pump group),and at 2,6,12,and 24h after operation.Results There was no operation-related death in two groups.One died of respiratory failure 14 days after operation in the hospital in off-pump group,there were more respiratory complications in on-pump group than that in off-pump group,and PaO_2/FiO_2 in on-pump group was higher than that in off-pump group at CPB 30min(at the start of operation),but lower than that in off-pump group postoperative at 6 h,12 h(P<0.05),the concentration of plasma ICAM-1 had obvious difference between two groups from CPB 30 min(at the start of operation) to post-operative 24 h(P<0.05).The neutrophils in bronchoalveolar lavage in on-pump group was higher than that in off-pump group from CPB 30 min(at the start of operation) to 24 h after operation(P<0.05).Conclusion Off-pump CABG seems more suitable than on-pump CABG for coronary artery disease patients with COPD due to less damage on oxygen-exchange capability and less respiratory complication.