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微创体外循环在冠状动脉旁路移植术中初步临床应用分析

Analysis in primary clinic outcomes of minimal extracorpeal circulation in the coronary artery bypass grafting

摘要:

目的 比较微创体外循环(MECC)与传统体外循环(cECC)的早期临床结果.方法 2006年8月至10月将40例接受冠状动脉旁路移植术(CABG)的患者随机分为MECC组和cECC组.每组20例.记录所有患者的一般情况、围手术期各项临床检查结果、术后合并症等,进行组间对比分析.结果 两组性别、既往史、术前心脏功能无差异;但MECC组患者年龄、术前手术风险评分和预期死亡率评分高于cECC组.两组患者手术时间、转流时间、阻断时间、移植旁路血管数量无明显差异.MECC组cTNI转后2、6和12 h均低于cECC组;氧合指数在转后12 h高于cECC组.cECC组在转后早期ALT和TBIL均高于正常范围;ALT在转后2、6 h,TBIL在停机、转后2 h均高于MECC组.MECC组术后活化部分凝血活酶时间均在正常范围之内;而cECC组在转后早期明显延长,并在转后2、6和12 h高于MECC组.cECC组血浆游离血红蛋白在转后2 h高于MECC组.两组血肌酐、血小板计数、白细胞计数无明显差异.结论 与cECC相比MECC具有更好的生物相容性,安全可靠.MECC可减轻各器官的功能损伤,降低术后并发症率,尤其对于高危患者效果显著.

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abstracts:

Objective To analysis comparatively the primary clinic outcomes between minimal extracorporeal circulation (MECC) and conventional extracorporeal circulation (cECC). Methods Forty cases accepted coronary artery bypass grafting from August to October at 2006 were divided into MECC group and cECC group at random, 20 cases for each group. Record and analysis of the general information, clinic data perioperatively, and complications postoperatively for each group were performed. Results There were no deference between groups in gender, anamnesis and preoperative cardiac function, while age (P<0.05), standard EuroSCORE and logistic EuroSCORE were much more higher in MECC group than in cECC group (P<0.01). Similarly, there were no deference in operative time, bypass time, ischemic time and graft number between two groups. Contrasted with cECC group, the values of cTNI were lower in MECC group at 2 h, 6 h and 12 h post-ECC (P<0.01), oxygen index were higher post-operatively and there was a statistic deference at 12 h post-ECC (P<0.05). The valves of ALT and TBIL in cECC group were higher abnormally at early post-ECC, and significant higher than in MECC group at 2 h, 6 h post-ECC of ALT (P<0.05), and at termination, 2 h post-ECC of TBIL (P<0.05). The values of actived partial thromboplastin time were almost at physiological status in MECC group, but were significantly prolonged in cECC group at early post-ECC, and were statisticly longer than in MECC group at 2 h, 6 h, 12 h post-ECC (P<0.05). The concentration of free hemoglobin in cECC group were higher than in MECC group peri-operative, and there was a statistic deference at 2 h post-ECC (P<0.05). There were no deference between the two group in Cr, PLT and WBC. Conclusions Compared with cECC, MECC carries more biocompatibility, more safe and credible. MECC system can alleviate the organ injury postoperatively and decrease the incidence of complications, especially in high-risk patients.

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