目的:探讨吲哚布芬联合氯吡格雷预防冠状动脉旁路移植术(CABG)后大隐静脉桥血管再狭窄的临床疗效及安全性.方法:回顾性分析2019年1月～2020年12月某院收治的接受CABG术患者84例作为研究对象,根据术后接受抗血小板药物方案分为A组(n=34)和B组(n=50),A组患者术后给予吲哚布芬联合氯吡格雷治疗,B组给予阿司匹林联合氯吡格雷治疗.对患者展开为期1年的随访,对比两组患者随访期间大隐静脉桥血管再狭窄率、不良心血管事件和不良反应发生情况;对比两组患者手术前和随访结束时凝血功能指标.结果:A组患者大隐静脉桥血管再狭窄率(5.89％)与B组(8.00％)相比无统计学差异(P>0.05);随访期间,A组患者不良心血管事件发生率(2.94％)与B组(6.00％)相比无统计学差异(P>0.05);A组患者不良事件发生率(5.89％)低于B组(22.00％,P<0.05);两组患者术后1年纤维蛋白原(FIB)、D-二聚体(D-dimer)均降低,而血小板计数(PLT)升高(P<0.05).结论:相较于阿司匹林,吲哚布芬联合氯吡格雷预防CABG术后大隐静脉桥血管再狭窄的临床疗效更好且安全性较高.

Objective:To investigate the changes of hemodynamics, inflammation and blood gas after coronary artery bypass grafting under beating and cardiopulmonary bypass.Methods:The clinical data of 136 patients with coronary heart disease who underwent coronary artery bypass grafting in our hospital from June 2018 to June 2020 were analyzed retrospectively. According to the circulation mode, they were divided into non-stop beating group (68 cases) and cardiopulmonary bypass group (68 cases). The patients in the off-pump group were treated with off-pump coronary artery bypass grafting under cardiopulmonary bypass, and those in the off-pump group were treated with off-pump coronary artery bypass grafting under cardiopulmonary bypass. The changes of cardiac function, pulmonary function, hemodynamics and inflammation were analyzed.Results:The operation time, ICU stay time and hospitalization time [(185.65±22.91) min, (2.74±1.037) d and (7.48±2.22) d] in the non-stop beating group were significantly shorter than those in the cardiopulmonary bypass group [(223.77±36.97) min, (5.06±1.79) d and (11.67±3.52) d, t=5.036, 9.196, 13.198, P<0.05]. CK-MB and cTnI levels [(26.03±4.81) U/L and (7.86±2.51) μg/L] were significantly lower in the non-stop beating group than those in the cardiopulmonary bypass group [(43.44±5.85) U/L, (8.81±1.76) μg/L, t=18.971, 2.530, P<0.05]. The postoperative MVP [(76.88±2.63) mmHg (1 mmHg=0.133 kPa)] in the non-stop beating group was significantly lower than that in the cardiopulmonary bypass group [(66.99±2.91) mmHg, t=18.971, P<0.05]. The postoperative LVSWI [(27.25±1.93) g/(m·m 2)] in the non-stop beating group was significantly smaller than that in the cardiopulmonary bypass group [(22.62±1.56) g/(m·m 2), t=15.399, P<0.05]. The postoperative RVSWI in the non-stop beating group [(4.45±1.32) g/(m·m 2)] was significantly smaller than that in the cardiopulmonary bypass group [(2.97±0.93) g/(m·m 2), t=7.470, P<0.05]. The levels of interleukin (IL)-1β and tumor necrosis factor-α (TNF-α) in the non-stop beating group [(49.12±6.53) and (44.96±4.98) pg/ml] was significantly lower than those in the cardiopulmonary bypass group [(75.36±6.41) and (52.59±7.96) pg/ml, t=23.68, 6.703, P<0.05]. The lung compliance and airway resistance [(447.28±46.87) and (0.63±0.03) kPa/(L·S)] in the beating group were significantly lower than those in the cardiopulmonary bypass group [(667.09±39.45) and (0.87±0.05) kPa/(L·S), t=29.460, 35.390, P<0.05]. Conclusion:Compared with coronary artery bypass grafting under cardiopulmonary bypass, patients with beating coronary artery bypass grafting have rapid recovery of cardiopulmonary function, stable hemodynamics and low level of inflammation.

目的 探讨心脏瓣膜术联合冠状动脉旁路移植对心脏瓣膜病患者心肌损伤的影响.方法 选取2017年10月—2018年10月在新乡医学院第一附属医院治疗的心脏瓣膜病患者72例,依据入院时间单双数分为对照组和研究组.对照组进行心脏瓣膜术联合冠状动脉旁路移植非同期手术治疗;研究组进行心脏瓣膜术联合冠状动脉旁路移植同期手术治疗.比较两组心肌损伤指标水平、术后相关指标、不良事件发生状况及术后心功能指标水平.结果 两组T0、T1、T2时的心肌肌钙蛋白I(cTnI)、血清肌酸激酶同功酶MB(CK-MB)及N末端B型脑钠肽(NT-proBNP)在不同时间、不同组间及变化趋势上有差异(P<0.05).两组体外循环前cTnI、CK-MB、NT-proBNP水平比较,差异无统计学意义(P>0.05);血运重建后cTnI、CK-MB水平均持续升高,研究组低于对照组;同时两组T0、T1时的NT-proBNP水平无变化,研究组T2时的NT-proBNP水平低于对照组(P<0.05).两组呼吸机应用时间、重症加强护理病房监护时间及住院时间与比较,差异有统计学意义(P<0.05),研究组较对照组少.两组不良事件总发生率比较,差异有统计学意义(P<0.05),研究组较对照组低.两组术前心功能指标比较,差异无统计学意义(P>0.05).两组术后左心室射血分数、左心室舒张末期前后径、左心室收缩末期前后径及心胸比等心功能指标比较,差异有统计学意义(P<0.05),研究组受损程度低于对照组.结论 心脏瓣膜术联合冠状动脉旁路移植是心脏瓣膜病患者治疗的有效方式.2种术式同期进行,有利于降低对患者心肌损伤的影响.术前积极改善患者心肺功能能够加强心肌保护,缩短心肌缺血时间,避免术后感染,有利于降低不良事件的发生概率,提升患者心功能指标水平,对促进患者康复有重要意义.

目的:检测基质Gla蛋白(MGP)在主动脉瓣膜钙化中的表达情况,反映MGP与主动脉瓣膜钙化的关系.方法:需行瓣膜无病变的马方综合征及主动脉夹层患者的主动脉瓣膜做对照组;单纯主动脉钙化需行主动脉置换患者的主动脉瓣膜做试验组,按术前超声分为中度、重度钙化组;术前30min分别取两组患者血标本;Elisa法、Western-Blot法测定对照组及试验组血清及瓣膜组织中MGP水平.结果:试验组中血清及瓣膜中MGP水平明显低于对照组.结论:MGP水平与主动脉瓣膜钙化具有相关性.