冠状动脉旁路移植术治疗肌钙蛋白I恢复正常后急性心肌梗死

目的 急性心肌梗死(AMI)后肌钙蛋白I(cTnI)的升高和降低可以指导治疗和预测冠状动脉旁路移植术(CABG)围手术期并发症及预后,探讨急性心肌梗死在肌钙蛋白I恢复正常后行冠状动脉旁路移植术的手术效果。方法 2011年1月至2015年12月236例患者在急性心肌梗死后肌钙蛋白I恢复正常后30天内行CABG术,所有病人均测定术前、术后cTnI变化和持续时间。其中,男138例、女98例,年龄43～86岁,平均(63.53±9.26)岁;非ST段抬高性心肌梗死189例,ST段抬高性心肌梗死47例。术中行非体外循环CABG(OPCABG)229例,体外循环辅助心脏不停跳下CABG(on pump beating heart CABG)术7例。 结果 心梗后肌钙蛋白I恢复正常时间为2-18天,平均(5.41±3.25)天,心梗后手术时间4-29天,平均(9.32±7.15)天,搭桥数1-5支,平均(2.61±1.23)支,应用主动脉内球囊反搏(IABP)8例,住院死亡3例,死亡率1.69%(3/236)。结论 血流动力学相对稳定的AMI患者cTnI正常后尽早行CABG可以取得良好的治疗效果。

Coronary Artery Bypass Grafting in Acute Myocardial Infarction with Normal Cardiac Troponin I

Objective To assess the clinical results of coronary artery bypass grafting (CABG) in acute myocardial infarction (AMI) patients who cardiac troponin I(cTnI) recoverd normal within 30 days.Methods The data of 236 AMI cases with cardiac troponin I is recoverd normal within 30 days who underwent CABG from January 2011 to December 2015 were analysised retrospectively. The cTnI changes and duration all cases were tested in preoperative and postoperative. Results The time of cTnI normal after myocardial infarction is 5.41±3.25 days from 2 day to 18 day. The operation time after myocardial infarction was 9.32±7.15 days from 4 day to 29 day. The mean number of bypass grafts was 2.61±1.23 from 1 to 5. the intra-aortic balloon pumping was used in 8 cases. the mortality is 1.69%(3/236).Conclusion In hemodynamical stable patients,the operational is feasible and effective to perform CABG after cTnI normal within 30 days after AMI.