腹主动脉瘤开腹手术与腔内修复术后心肌损伤比较

目的：比较腹主动脉瘤开腹手术与腔内修复术后心肌损伤程度.方法：收集75例腹主动脉瘤开腹切除手术和67例腔内修复手术患者的临床资料,根据患者冠状动脉CT造影（CTA）检查结果所示狭窄程度将所有病例分为轻、中、重三组,CTA示至少一处≥75％狭窄者为重度狭窄组,至少一处≥50％狭窄者为中度狭窄组,狭窄均＜50％者为轻度狭窄组.以肌钙蛋白I（cTnI） ≥0.01 μg/L为升高.每组进行两种术式病史资料及术后24h cTnI升高情况的比较.结果：中度狭窄组腔内介入13例,共6例术后cTnI升高,发生率46％;开腹手术15例中13例术后cTnI升高,发生率87％,两者比较,差异有统计学意义（P =0.042）.轻度狭窄及重度狭窄组腔内介入与开腹手术术后cTnI升高发生率差异无统计学意义（P＞0.05）.结论：冠状动脉中度狭窄患者腔内修复术较开腹手术术后心肌损伤发生率低.

Myocardial injury following open surgery and endovascular repair for abdominal aortic aneurysm

Objective：To investigate myocardial injury following open surgery（OS） for abdominal aortic aneurysm compared with endovaseular repair（EVR）. Methods：The clinical data of 142 patients with abdomi- nal aortic aneurysm treated by open surgery （n = 75 ） and endovascular repair （n = 67 ） were analyzed. All pa- tients were divided into three groups according to the results of coronary CTA. The patients with coronary CTA displaying at least one stenosis ≥75% were divided into the group of severe stenosis, the ones with at least one stenosis ≥50% were moderate, and those with stenosis 〈 50% were mild. The clinical data and post-operative elevated cTnI （ ≥0.01 μg/L） rate were compared between OS and EVR in every group. Results ：In the group of moderate stenosis, elevated cTnI was found in 6 of the 13 patients treated by EVR（46% ） and in 13 of the 15 patients treated by OS. There was statistically significant difference between two surgeries （ P = 0. 042 ）, but there was no statistically significant difference in the groups of severe or mild stenosis. Conclusion： Myocardial injury rate after EVR is lower than that after OS in the patients with moderate stenosis.