老年人非体外循环冠状动脉旁路移植术的心肌保护作用

目的比较70岁以上老年人非体外循环冠状动脉旁路移植术(OPCAB)和体外循环冠状动脉旁路移植术(CABG)围术期心肌损伤程度,探讨OPCAB的心肌保护效果。方法30例老年患者分为两组,A组15例,为CABG组,B组15例,为OPCAB组。分别于术前、术中30min、术中1h、术后6h、12h、24h、72h、120h取静脉血标本,分别测定心肌肌钙蛋白I(cTnI)水平和CKMB活性;另外记录围手术期各项临床指标。结果OPCAB组术后辅助呼吸时间较CABG组短(P<0.01),而且主动脉球囊反搏和输血例数较低(P<0.05)。CABG组与OPCAB组cTnI、CKMB的术前水平相,术后6hcTnI即有升高而后下降,术后30min至72h均较OPCAB组明显升高(P<0.05或0.01)。结论与CABG相比,OPCAB的心肌损伤较轻,心肌保护效果较好。

Myocardial protective effect of Off-Pump coronary artery bypass grafting in the aged

Objective To explore the protective effect of coronary artery bypass grafting(CABG) with or without cardiopulmonary bypass(CPB) in myocardial injury in the aged patients.Methods Thirty patients subject to simple CABG were randomly divided into 2 groups:CABG group(n=15),on pump with conventional CPB,and OPCAB group(n=15),off pump with beating heart.Serum levels of cardiac troponin I(cTnI) and CK-MB activity were detected right before operation,30 min,1 h,6 h,12 h,24 h,72 h and 120 h after operation.Results In the CABG group with pump in 12 h,24 h,72 h postoperation,the cTnI and CK-MB levels and the number of the patients receiving IABP and transfusion were significantly increased as compared with OPCAB group(P<0.05).Conclusion Off-pump coronary artery bypass grafting in beating heart can reduce myocardial injury.