不停跳冠状动脉搭桥术与缺血预处理的心脏保护效果

[目的]探讨缺血预处理及不停跳冠状动脉搭桥术在冠状动脉外科中的心脏保护作用.[方法]43例常规体外循环搭桥手术及32例不停跳手术患者.不停跳冠状动脉搭桥术患者随机分为缺血预处理组和对照组.缺血预处理组采用2周期阻断前降支2min,然后开放3min.对比常规手术与不停跳冠状动脉搭桥手术术后心功能及心肌酶改变.[结果]术后右室射血分数和心指数在不停跳冠状动脉搭桥术中明显优于常规体外循环搭桥手术.不停跳冠状动脉搭桥术组术后心脏肌钙蛋白释放也显著性降低.在不停跳冠状动脉搭桥术患者,缺血预处理显著性降低术后心脏肌钙蛋白释放.[结论]不停跳冠状动脉搭桥术有利于术后心功能恢复.缺血预处理有效保护不停跳冠状动脉搭桥术心肌缺血再灌注损伤.

Off-pump Coronary Artery Bypass Grafting and the Protective Effects of IschemicPreconditioning

Objective To investigate the difference between routine cardiopulmonary bypass coronary artery bypass grafting (CABG) and off-pump CABG, and the protective effects of ischemic preconditioning (IP) on off-pump CABG. Methods Forty-three on-pump and thirty two off-pump CABG patients were included. Off-pump patients were equally randomized as the IP group and the controls. IP protocol was induced by 2 periods of 2-min left anterior descending artery (LAD) occlusion followed by 3-min LAD reperfusion. Results The hemodynamic recovery, including right ventricular ejection fraction (P<0.001) and cardiac index (P<0.001) was better in off-pump group. The release of cardiac troponin I (CTnI) after the operation in this group was significantly decreased (P=0.018). IP resulted in the lower CTnI release in off-pump patients (P=0.044). Conclusion Off-pump procedure has beneficial effects on the postoperative recovery in CABG patients. IP effectively protects the myocardium from ischemia reperfusion injury.