摘要目的 评价并行体外循环下不停跳冠状动脉旁路移植术在冠状动脉左主干病变中的应用价值.方法 回顾性分析郑州大学人民医院心外科2009年1月至2012年1月114例接受冠状动脉旁路移植术的冠状动脉左主干病变患者术前及围手术期临床资料,其中48例在传统的体外循环心脏停跳下手术(简称停跳组),另66例在并行体外循环不停跳下手术(简称并循组).结果 术后并循组的临床效果优于停跳组,并循组体外循环时间、呼吸机辅助时间、重症监护病房停留时间、肌钙蛋白恢复时间均短于停跳组,差异均有统计学意义[(89±25)比(117±28) min,(15±14)比(27±19)h,(57±27)比(79±34)h,(6.2±1.8)比(7.0±2.4)d,均p＜0.05].两组血浆肌钙蛋白I在术前差异无统计学意义,但在转机后各时间点比较差异均有统计学意义[并循组比停跳组:转机0.5h:(0.132 ±0.022)比(0.265 ±0.014) μg/L,转机1 h:(0.341 ±0.027)比(0.572±0.046) μg/L,术后1h:(0.641 ±0.036)比(0.932±0.047) μg/L,术后6 h:(1.212 ±0.765)比(1.627 ±0.542) μg/L,术后24 h:(1.496 ±0.263)比(1.734 ±0.328)μg/L,均P＜0.05].结论 并行体外循环下不停跳冠状动脉旁路移植术可以降低冠状动脉左主干病变患者术中风险,减轻心肌损伤,是一种安全、有效的手术方式.

abstractsObjective To explore the value of on-pump beating-heart coronary artery bypass grafting (OnP-BH CABG) for left-main patients with coronary heart disease through a comparative study with conventional coronary artery bypass grafting (CCABG).Methods The clinical data were retrospectively analyzed for 66 patients of OnP-BH and 48 control cases undergoing CCABG from January 2009 to January 2012 at Department of Cardiac Surgery,People's Hospital of Zhengzhou University.Results OnP-BH group had a better clinical outcome than CCABG group.There were obvious statistical difference in cardiopulmonary bypass (CPB) time,mean ventilation time,intensive care unit stay and recovery time of plasma cardiac troponin I (OnP-BH group vs CCABG group:(89 ±25)vs(117 ±28)min,(15 ± 14) vs(27 ± 19)h,(57 ± 27) vs (79 ± 34) h,(6.2 ± 1.8) vs (7.0 ± 2.4) d,all P ＜ 0.05).The data of preoperative cTnI showed no significant difference between two groups(P ＞0.05).However,after CPB,significant intergroup difference existed in the level of cTnI (μg/L) OnP-BH group vs CCABG group:(0.5 h after CPB:(0.132 ± 0.022) vs(0.265±0.014),1 h after CPB:(0.341 ±0.027)vs(0.572 ±0.046),1 h after operation:(0.641 ± 0.036) vs(0.932 ± 0.047),6 h after operation:(1.212 ± 0.765) vs (1.627 ± 0.542) and 24 h after operation:(1.496 ± 0.263) vs (1.734 ± 0.328),all P ＜ 0.05).Conclusions On-pump beating-heart coronary artery bypass grafting is a feasible surgical approach for left-main patients.And it has a low risk and causes less myocardial damage.