Clinical Analysis Of Patients With Intravenous Heparin Therapy Early After Off-pump Coronary Artery Bypass Grafting

Background:It hardly to avoid the mechanical and ischemia reperfusion injury of the bypass vessels during coronary artery bypass grafting. The destruction of vascular endothelial cells, the release of collagen fibers and the release of tissue factor resulted in the aggregation, adhesion and activation of the platelet. A variety of coagulation factors are released causing the spasm of vessels and acute thrombosis, resulting in the occurrence of perioperative myocardial infarction. How to reduce the incidence of myocardial infarction after coronary artery bypass grafting has been a very important problem for surgeons, which is directly related to the success of the operation, the early recovery of patients and the long-term effect of the operation.Objective:To evaluate the clinical efficacy and safety of anticoagulation by using heparin sodium after coronary artery bypass grafting without cardiopulmonary bypass.Methods:We use case control study. Patients who were routinely injected with heparin sodium after coronary artery bypass grafting from March 1,2014 to June 2015,30 in our hospital were selected as the experimental group and the patients who were not given heparin sodium from February 28,2014 to January 1,2013 were selected as the control group. All patients underwent coronary artery bypass grafting without cardiopulmonary bypass after they were diagnosed by clinical diagnosis and coronary angiography. The data when patients admitted the hospital, the examination results after surgery, the number of cardiac death, congestive heart failure, recurrent ischemic episodes of angina, perioperative myocardial infarction, malignant arrhythmia and thoracotomy of the two groups were compared. The volumes of drainage fluid were compared too.Results:There were no significant differences between the two groups in the general situation, the results of coronary angiography. No significant difference was found in the number of bypass vessels.There was no significant difference in the results of the general test. But in the experimental group, Troponin T and creatine kinase MB in the experimental group were lower than the control group (P<0.05) and it recovered more quickly in the experimental group than in the control group. There was no death, no congestive heart failure, no recurrent angina pectoris and malignant arrhythmia. The volume of drainage fluid in the experimental group was higher than that in the control group (913±164.8ml vs 810.1±148.5ml, t=6.767,P=0.000), but there was no significant difference between the two groups in the rate of reoperation for bleeding and blood transfusion.Conclusion:Continuous using of heparin sodium after coronary artery bypass grafting without cardiopulmonary bypass in the condition of a suitable period of ACT reduces the TNT and CKMB levels and myocardial injury.