摘要
目的探讨非体外循环冠状动脉旁路移植术(OPCAB)与体外循环冠状动脉旁路移植术(CABG)治疗对老年冠心病患者脏器损伤及Th1/Th2免疫平衡的影响。方法将2014年11月~2016年11月于宜宾市第一人民医院就诊的老年冠状动脉粥样硬化性心脏病(冠心病)患者102例按随机数字表法分为两组,平均年龄为(73.5±5.4)岁。OPCAB组与CABG组各51例,两组性别、年龄等差异无统计学意义。对比两组治疗效果及手术并发症(指标包括桥血流量、输血量、血管搭桥数、气管插管时间、呼吸机使用时间、呼吸衰竭发生率、二次开胸率、新发心房颤动率、住院时间、死亡率、肺部感染发生率、急性肾衰发生率、脑梗死发生率)。检测患者脏器损伤的生化指标,包括肌酸激酶同工酶(CK-MB)、心肌肌钙蛋白I(c Tn I)、谷草转氨酶(AST)、谷丙转氨酶(ALT)、血清肌酐(Scr)及尿素氮(BUN)水平及Th1/Th2免疫平衡指标,包括干扰素γ(INF-γ)、白介素-4(IL-4)、INF-γ/IL-4水平。结果 OPCAB组桥血流量、输血量、血管搭桥数、气管插管时间、呼吸机使用时间、呼吸衰竭发生率、二次开胸率、新发心房颤动率、住院时间、死亡率、肺部感染发生率、急性肾衰发生率、脑梗死发生率均明显低于CABG组(P均<0.05)。OPCAB组在术后4 h、8 h、12 h、24 h及48 h CK-MB、c Tn I、AST、ALT、Scr及BUN水平均明显低于CABG组(P均<0.05),肺功能氧合指数(OI)明显高于CABG组(P<0.05)。不同时间点各组间INF-γ、IL-4、INF-γ/IL-4水平差异无统计学意义(P均>0.05)。结论 OPCAB法与CABG法对老年冠心病患者脏器均有一定损伤,且影响机体Th1/Th2免疫平衡,但OPCAB法损伤程度小,治疗效果更佳。
Objective To investigate the influences of off-pump coronary artery bypass grafting （OPCABG） coronary artery bypass grafting （CABG） on organ damage and Th1/Th2 immune balance in elderly patients with coronary heart disease （CHD）. Methods Elderly CHD patients （n=102 and average age=73.5±5.4） were chosen from the First People’s Hospital of Yibin City from Nov. 2014 to Nov. 2016, and then randomly divided into OPCABG group and CABG group （each n=51）. The difference in sex and age had no statistical significance between 2 groups. The curative effects （including bypass flow volume, transfusion volume, number of bypass vessels, intubation duration and mechanical ventilation duration） and surgical complications （including incidence of respiratory failure, second chest-open surgery and new-onset atrial fibrillation, duration of hospital stays, mortality, and incidence of pulmonary infection, acute renal failure and cerebral infarction） were compared between 2 groups. The levels of biochemistry indexes of organ damage including creatine kinase-M B isoenzyme （CK-MB）, cardiac troponin I （cTnI）, aspertate aminotransferase （AST）, alanine aminotransferase （ALT）, serum creatinine （SCr） and blood urea nitrogen （BUN）, and indexes of Th1/Th2 immune balance including interferon γ （IFN-γ）, interleukin-4 （IL-4） and ratio of INF-γ to IL-4 （INF-γ/IL-4） were detected. Results The bypass flow volume, transfusionvolume, number of bypass vessels, intubation duration and mechanical ventilation duration, and incidence of respiratory failure, second chest-open surgery and new-onset atrial fibrillation, duration of hospital stays, mortality, and incidence of pulmonary infection, acute renal failure and cerebral infarction were all significantly lower in OPCABG group than those in CABG group （all P〈0.05）. The levels of CK-MB, cTnI, AST, ALT, SCr and BUN were significantly lower （all P〈0.05）, and oxygenation index （OI） was significantly higher （P〈0.05） in OPCABG group than those in CABG group after the surgery for 4 h, 8 h, 12 h, 24 h and 48 h. The difference in levels of INF-γ, IL-4 and INF-γ/IL-4 had no statistical significance between 2 groups at all time points （all P〉0.05）. Conclusion OPCABG and CABG both can induce organ damage and influence Th1/Th2 immune balance, while OPCABG has less damage and higher curative effect in elderly CHD patients.
出处
《中国循证心血管医学杂志》
2017年第6期712-715,718,共5页
Chinese Journal of Evidence-Based Cardiovascular Medicine
关键词
OPCAB
CABG
冠心病
脏器损伤
免疫
Off-pump coronary artery bypass grafting
Coronary artery bypass grafting
Coronary heart disease
Organ damage
Immunity
