作者：王保申，史坚，张静波，骆静武，傅群峰，高丛

单位：

1.071000 河北省保定市第一中心医院心脏血管外科 2.071000 河北省保定市第一中心医院超声科 3.071000 河北省保定市第一中心医院胸外科 通信作者：王保申，E-mail：baoshen7474@sina.com

Units：

1.Department of Cardiovascular Surgery, Baoding No.1 Central Hospital, Baoding 071000, China 2.Department of Ultrasonography, Baoding No.1 Central Hospital, Baoding 071000, China 3.Department of Thoracic Surgery, Baoding No.1 Central Hospital, Baoding 071000, China Corresponding author: WANG Baoshen, E-mail: baoshen7474@sina.com

关键词：

心室功能障碍,左; 左西孟旦; 冠状动脉旁路移植术,非体外循环; 心肌保护;

Keywords：

Ventricular dysfunction, left; Levosimendan; Coronary artery bypass, off-pump; Myocardial protection

CLC：

DOI：

10.12114/j.issn.1008-5971.2022.00.012

Funds：

保定市科技计划项目（1941ZF034）

摘要：

背景非体外循环冠状动脉旁路移植术(OPCABG)是目前临床治疗严重冠状动脉病变的主要手术方式,而减轻OPCABG后早期心肌缺血再灌注损伤有利于改善心肌功能、减少术后并发症的发生。目的探讨预防性应用左西孟旦对左心室功能障碍患者OPCABG后早期心肌功能的影响。方法选取保定市第一中心医院2019年6月至2021年6月收治的行OPCABG的左心室功能障碍患者48例,根据随机数字表法分为对照组16例和试验组32例。行OPCABG前,对照组采用标准治疗,试验组在对照组基础上于OPCABG前24 h应用左西孟旦注射液。比较两组患者术前及术后48 h生命体征[体温(T)、心率(HR)、收缩压(SBP)、舒张压(DBP)]、左心功能[左心室射血分数(LVEF)]及实验室检查指标[乳酸(Lac)、血肌酐(Scr)、血尿素氮(BUN)、白细胞计数(WBC)、血红蛋白(HGB)、中性粒细胞百分比(NEUT%)],术前及术后1、6、12、48 h心肌功能指标[高敏肌钙蛋白I(hsTnI)、肌酸激酶同工酶(CK-MB)、B型脑钠肽(BNP)],手术及预后情况。结果试验组患者术后48 h WBC、NEUT%低于对照组(P <0.05)。试验组患者术后1、6 h hs-TnI、CK-MB、BNP水平低于对照组(P <0.05)。对照组患者术后1、6、12、48 h hs-TnI、CK-MB、BNP水平分别高于本组术前(P <0.05);试验组患者术后6、12、48 h hs-TnI水平,术后1、6、12、48 h CK-MB水平,术后12、48 h BNP水平分别高于本组术前(P <0.05)。对照组患者术后6 h hs-TnI、CK-MB水平分别高于本组术后1 h(P <0.05);试验组患者术后6、12 h hs-TnI水平,术后6 h CK-MB水平,术后12、48 h BNP水平分别高于本组术后1 h(P <0.05)。对照组患者术后48 h CK-MB水平低于本组术后6 h(P <0.05);试验组患者术后48 h hs-TnI水平及术后12、48 h CK-MB水平分别低于本组术后6 h,术后12、48 h BNP水平分别高于本组术后6 h(P <0.05)。试验组患者低心排血量综合征(LCOS)发生率低于对照组(P<0.05)。结论术前预防性应用左西孟旦可有效减轻左心室功能障碍患者OPCABG后早期心肌损伤及炎性反应,且可降低LCOS发生风险。

Abstract：

【Abstract】 Backgroud Off-pump coronary artery bypass grafting (OPCABG) is the primary surgical method forthe clinical treatment of severe coronary artery disease, reducing early myocardial ischemia-reperfusion injury after OPCABG isconducive to improve myocardial function and reduce postoperative complications. Objective To discuss the effect of preventiveapplication of levosimendan on early myocardial function after OPCABG in left ventricular dysfunction patients. Methods A totalof 48 patients with left ventricular dysfunction undergoing OPCABG in Baoding No.1 Central Hospital from June 2019 to June 2021were selected, and divided into 16 cases in the control group and 32 cases in the experimental group according to random numbertable method. Patients in the control group were given standard treatment before operation, and patients in the experimental groupwere given levosimendan injection 24 hours before operation on the basis of the control group. Vital signs [temperature (T) , heartrate (HR) , systolic blood pressure (SBP) , diastolic blood pressure (DBP) ] , left ventricular function [left ventricular ejectionfraction (LVEF) ] and laboratory examination indexes [lactic acid (Lac) , serum creatinine (Scr) , blood urea nitrogen (BUN) ,white blood cell count (WBC) , hemoglobin (HGB) and percentage of neutrophils (NEUT%) ] before operation and at 48 hoursafter operation, myocardial function indexes [high sensitivity troponin I (hs-TnI) , creatine kinase isoenzyme (CK-MB) , B-typenatriuretic peptide (BNP) ] before operation and at 1, 6, 12, 48 hours after operation, condition of operation and prognosis werecompared between the two groups. Results WBC and NEUT% at 48 hours after operation in the experimental group were lowerthan those in the control group (P < 0.05) . Levels of hs-TnI, CK-MB and BNP at 1, 6 hours after operation in the experimentalgroup were lower than those in the control group (P < 0.05) . Levels of hs-TnI, CK-MB and BNP at 1, 6, 12 and 48 hours afteroperation in the control group were higher than those before operation, respectively (P < 0.05) ; level of hs-TnI at 6, 12, 48hours after operation, level of CK-MB at 1, 6, 12, 48 hours after operation, level of BNP at 12, 48 hours after operation in theexperimental group were higher than those before operation , respectively (P < 0.05) . Levels of hs-TnI, CK-MB at 6 hours afteroperation in the control group were higher than those at 1 hour after operation, respectively (P < 0.05) ; hs-TnI level at 6, 12 hoursafter operation, CK-MB level at 6 hours after operation, and BNP level at 12, 48 hours after operation in the experimental groupwere higher than those at 1 hour after operation, respectively (P < 0.05) . CK-MB level at 48 hours after operation in the controlgroup was lower than that at 6 hours after operation, respectively (P < 0.05) ; hs-TnI level at 48 hours after operation and levelof CK-MB at 12, 48 hours after operation in the experimental group were lower than those at 6 hours after operation, BNP levelat 12, 48 hours after operation was higher than that at 6 hours after operation, respectively (P < 0.05) . Incidence of low cardiacoutput syndrome (LCOS) in the experimental group was lower than that in the control group (P < 0.05) . Conclusion Preventiveapplication of levosimendan can effectively alleviate the early myocardial injury and inflammatory reaction after OPCABG in leftventricular dysfunction patients, and reduce the risk of LCOS.

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