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*

Effect of cardiac valvular surgery combined with coronary artery bypass grafting on myocardial injury in patients with cardiac valvular disease*

摘要:

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。

Abstract:

Objective To investigate the effect of cardiac valvular surgery combined with coronary artery bypass grafting on myocardial injury in patients with cardiac valvular disease. Methods A total of 72 cases of patients with cardiac valvular disease admitted to our hospital from October 2017 to October 2018 were enrolled. According to whether the admission date is an odd or even number, the participants were divided into control group and research group. The control group received cardiac valvular surgery combined with coronary artery bypass grafting at different periods, while the research group underwent cardiac valvular surgery combined coronary artery bypass grafting during the same period. The indicators of myocardial injury and postoperative condition, adverse events and postoperative cardiac function indicators were compared between the two groups. Results The levels of cardiac troponin Ⅰ (cTnⅠ), creatine kinase-MB (CK-MB) and N-terminal prohormone of brain natriuretic peptide (NT-proBNP) were different at T0, T1 and T2 between the groups, and the changing trends of these indicators between the two groups were as well different (P??0.05). After revascularization, cTnI and CK-MB levels were increased and those in the research group were significantly lower than those in the control group (P??0.05), and the degree of damage of cardiac function as indicated by left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD), cardiothoracic ratio and other indexes in research group was lower than that in the control group after the surgery (P?