| 51 | 0 | 12 |
| 下载次数 | 被引频次 | 阅读次数 |
目的:比较非体外循环冠状动脉搭桥术(off-pump CABG)与体外循环冠状动脉搭桥术(on-pumpCABG)2种手术方式对心肌的损害。方法:将30例行冠脉搭桥病人分为off-pump组与on-pump组,观察2种手术方式围手术期(插管前和术后8、16、24、36、48、72、96 h)血清肌钙蛋白T(TNT)、肌酸激酶-同工酶(CK-MB)水平及术后心电图变化,并进行评价。结果:2组病人术前TNT、CK-MB均正常。术后各时间点TNT值监测:off-pump组3例(20%)、on-pump组12例(80%)升高,差异有统计学意义(P<0.05)。术后2组病人各时间点CK-MB均升高,off-pump组术后24 h达高峰,on-pump组术后36 h达高峰,峰值差异有统计学意义(P<0.05)。术后心电图监测未发现有新的Q波形成及ST-T改变。结论:off-pump CABG对心肌损伤较小。
Abstract：Objective: To compare the myocardial injury of the off-pump CABG with on-pump CABG. Methods: To observe the changes of troponin T(TNT), creatinine kinase isoenzyme(CK-MB) and ECG during the time of the surgery (before intubation and 8、16、24、36、48、72、96 h after operation) and evaluate the results. Results: TNT, CK-MB were all normal before surgery, Observing every time of TNT in two gropes after surgery, in 3 patients TNT were elevated in off-pump grope and 12 patients in on-pump grope, the difference had statistical significance(P<0.05), every time of CK-MB elevated in both groups after surgery, the peak level appeared 24 h in off-pump and 36 h in on-pump after surgery. The peak difference has statistical significance(P<0.05). There were not new Q waves and the changes of ST-T after surgery. Conclusion: Compared with on-pump CABG, off- pump CABG has little myocardial injury.
[1]Jayme S,Robert A,Iain K,et al.Assessment of myocardialinjury by troponin T in off-pump coronary artery grafting andconventional coronary artery graft surgery[J].ANZ J Surg,2002,72(2):105-109.
[2]Kathiresan S,MacGillivray TE,Lewandrowski K.Off-pumpcoronary bypass grafting is associated with less myocardial in-jury than coronary bypass surgery with cardiopulmonary by-pass[J].Heart Surg Forum,2003,6(6):174-178.
[3]Masuda M,Morita S,Tomita H,et al.Off-pump CABG at-tenuates myocardial enzyme leakage but not postoperativebrain natriuretic peptide secretion[J].Ann Thorac CardiovascSurg,2002,8(3):139-144.
[4]Peivandi AA,Hake U,Dahm M,et al.Coronary revascular-ization:off-pump versus on-pump-a comparison of behavior ofbiochemical cardiac ischemia markers[J].Z Kardiol,2002,91(3):203-211.
[5]Giedraitis S,Benetis R,Dumcius A.“Off-pump”myocardialrevascularization:experience in the Clinic of Cardiosurgery[J].Kaunas University of Medicine Medicina(Kaunas),2004,40:48-53.
[6]Cartier R.Current trends and technique in OPCAB surgery[J].J Card Surg,2003,18(1):32-46.
[7]Patel NC,Pullan DM,Fabri BM.Does off-pump total arterialrevascularization without aortic manipulation influence neuro-logical outcome?A study of 226 consecutive,unselected cases[J].Heart Surg Forum,2002,5(1):28-32.
[8]Carrier M,Pellerin M,Perrault LP,et al.Troponin levels inpatients with myocardial infarction after coronary artery by-pass grafting[J].Ann Thorac Surg,2000,69:435-440.
[9]Etievent JP,Chocron S,Forssell G,et al.Myocardial releaseof troponin T after coronary bypass surgery[J].Scand J Tho-rac Cardiovasc Surg,1994,28:67-72.
[10]Movahed A,Nair KG,Ashavaid TF,et al.Evidence for free-radical mediated injury during coronary artery bypass surgery[J].Indian Heart J,1995,47(2):107-111.
[11]Shiga T,Terajima K,Matsumura J,et al.Minor cardiac tro-ponin T release in patients undergoing coronary artery bypassgraft surgery on a beating heart[J].J Cardiothorac VascAnesth,2000,14(2):151-155.
[12]Birdi I,Fr CS,Angelini GD,et al.Biochemical markers ofmyocardial injury during cardiac operations[J].Ann ThoracSurg,1997,63:879-888.
[13]Calafiore AM,Di Mauro M,Canosa C,et al.Myocardial re-vascularization with and without cardiopulmonary bypass:ad-vantages,disadvantages and similarities[J].Eur J Cardiotho-rac Surg,2003,24:953-960.
基本信息:
中图分类号:R654.2
引用信息:
[1]付真彦,马依彤,霍强.非体外循环、体外循环CABG术后TNT及CK-MB水平变化[J].新疆医科大学学报,2005(08):734-736.
2005-08-30
2005-08-30