| Objective: To observe the effect of recombinant Human Brain Natriuretic Peptide(rh BNP)to cardiac function of postoperative patients with Off-pump Coronary Artery Bypass Graft;To observe the effect of rh BNP to monitoring and the total time in hospital and the incidence of cardiovascular events of postoperativ patients with Off-pump Coronary Artery Bypass Graft;To observe the security of rh BNP.Methods:1 103 cases accepting the names of the same kind of Off-pump Coronary Artery Bypass Graft in our hospital are divided into rh BNP group and the control group with random number table method,52 cases with rh BNP group and control group in 51 cases.For the control group: normal line of Off-pump Coronary Artery Bypass Graft with conventional endotracheal intubation to the ICU treatment;For rh BNP groups: normal line of Off-pump Coronary Artery Bypass Graft with endotracheal intubation to the ICU based on regular treatment,intravenous pumping rh BNP(produced by chengdu di kang biological pharmaceutical co.,LTD.),to 1.5?g/kg static load to the first note,after 0.0075?g.kg-1 min-1,amount of maintaining continuous intravenous pumping 72 hours.2 Two groups of cases are completed under the static absorption composite endotracheal intubation anesthesia surgery;All routine indwelling needle placed in the left radial artery in order to direct monitoring blood pressure,in the right subclavian vein placed three cavity Arrow venous indwelling tube to pump into the drugs,in the right internal jugular vein into the Swan-Ganz catheter for testing related indicators,two groups of cases involved in operation and process are the same.Process is as follows: theconventional give disinfection in a chest midline incision after,according to the skin and subcutaneous muscle-periosteum cut in the order of longitudinal split top-down sternum,application of electrotome and bone wax full stop bleeding after free within the left thoracic artery(rib strays from 4 or 5,free up to 1,down free to xiphoid process),at the same time made great saphenous vein(full open ways),the left thoracic artery from the final cut,hanging pericardium and told the anesthesiologist intravenous application of heparin sodium(1 mg/kg).Using Beijing aerospace Kaldi HK series stabilizer fixed target heart blood vessels,conventional coronary artery lumen shunt placement bolt,7-0 Prolence continuous suture line end side,end to end anastomosis,usually within the first on the left side of the thoracic artery anastomosis with left anterior descending branch,and then use the great saphenous vein bridge proximal anastomosis,again ordinal sequential anastomosis diagonal branch,cyclotron system and right coronary system;Aortic Anastomosis auxiliary equipment should be used in the proximal Anastomosis(Anastomosis Assist Device),6-0 Prolence line continuous suture Anastomosis.In intraoperative blood vessels for flow measurement for all bridge,to ensure that every vein bridge traffic.3 Respectively in the preoperative and postoperative immediate(medicine)before and after 24 hours,48 hours after operation,postoperative 7days extraction of venous blood,detection of b-type brain natriuretic peptide(BNP)and troponin(c Tn I);Respectively in the preoperative and postoperative immediate(medicine)before and after 24 hours,48 hours after operation,line7 days postoperative cardiac color doppler echocardiography of left ventricular ejection fraction(LVEF);Respectively in the preoperative and postoperative immediate(medicine)before and after 24 hours,48 hours after operation,postoperative patients with 7 days to determine heart rate(CO)and pulmonary capillary wedge pressure(PAWP).4 Every time 3 ml blood sampling,blood within 30 minutes after 4 ?3000 r/min in the centrifuge centrifuge for 10 min,take that and supernatant fluid within 20 min to detect and record the BNP and c Tn I;By the samecardiac ultrasound doctors same machine line cardiac color doppler echocardiography and record LVEF.By the floating catheter placement success(the Swan-Ganz)monitoring and recording CO,PAWP.5 To observe the incidence of cardiovascular events.6 Measurement data using mean±standard deviation(SX ?),the group comparison using t-test,the comparison of two sample rate by chi-square test or Fisher's exact test.Results:1 two groups each have 1 case of intraoperative to cabg under extracorporeal circulation and termination of the study,the actual to participate in this study were: rh BNP group of 51 cases,control group of 50 cases.2 Two groups of patients with general information and bridge vascular comparison: rh BNP group of 29 men,women,21 people,average age 62±7,smokers 39 people,blood fat was abnormal 29 people,8 people,with diabetes mellitus combined with hypertension 24 people,an average of 51.24±3.26 left ventricular ejection fraction,and the average blood vessel bridge number3.31 ± 3.31,the average number of distal anastomosis 3.20 ± 0.40;Control group 31 males and female 19 people,average age 64±9,smokers 40 people,blood fat was abnormal 30 people,9 people,with diabetes mellitus combined with hypertension 27 people,an average of 50.34 ± 2.79 left ventricular ejection fraction,and the average blood vessel bridge number 3.19± 3.19,the average number of distal anastomosis 3.30 ± 0.31,comparing differences between the two groups had no statistical significance(P>0.05);Immediately(rh BNP group and the control group preoperative and postoperative medication before)the BNP and troponin comparison,there was no statistically significant difference(P>0.05).3 Rh BNP group and the control group before the BNP,there was no statistically significant difference(P>0.05);Immediate postoperative(medicine)before the BNP,there was no statistically significant difference(P>0.05);Postoperative BNP is 24 hours,the difference was statisticallysignificant(P<0.05);48 hours after the BNP comparison,the difference was statistically significant(P<0.01),postoperative BNP is 7 days,the difference was statistically significant(P<0.05).4 Rh BNP group and the control group compared preoperative c Tn I,there was no statistically significant difference(P>0.05);Immediately after before using this drug c Tn I comparison,there was no statistically significant difference(P>0.05);Postoperative c Tn I is 24 hours,the difference was statistically significant(P<0.05);CTn I 48 hour after comparison,the difference was statistically significant(P<0.05),BNP is 7 days postoperatively,there was no statistically significant difference(P>0.05).5 Rh BNP group and the control group compared preoperative LVEF,there was no statistically significant difference(P>0.05);Postoperative immediate(medicine)before LVEF compared,there was no statistically significant difference(P>0.05);LVEF 24 hour after comparison,the difference was statistically significant(P<0.05);LVEF 48 hour after comparison,the difference was statistically significant(P<0.01),postoperative LVEF is 7 days,the difference was statistically significant(P<0.05).6 Rh BNP group and the control group preoperative CO,there was no statistically significant difference(P>0.05);Postoperative immediately(before use)CO,there was no statistically significant difference(P>0.05);CO in 24 hour after the comparison,the difference was statistically significant(P<0.05);48 hours after CO comparison,the difference was statistically significant(P<0.01),postoperative CO is 7 days,the difference was statistically significant(P<0.05).7 Rh BNP group and the control group compared preoperative PAWP,there was no statistically significant difference(P>0.05);Immediately after(before using this drug)PAWP comparison,there was no statistically significant difference(P>0.05);PAWP 24 hour after comparison,the difference was statistically significant(P<0.05);PAWP 48 hour after comparison,the difference was statistically significant(P<0.01),PAWP 7 days after the comparison,the difference was statistically significant(P<0.05).8 Rh BNP group angina pectoris,ventricular arrhythmia,myocardial infarction,cardiac syndrome respectively,5 cases(9.8%),7 cases(13.7%),2cases(3.9%),and 0 case,control group in angina pectoris,ventricular arrhythmia,myocardial infarction,cardiac syndrome respectively,5 cases(10%),8 cases(16%),2 cases(4%)and 1 case(2%),no deaths have occurred in both groups.Two groups of patients in hospital during the happening of cardiovascular events and death has no statistically significant difference(?2=0.117,P=0.732 > 0.05).9 Average time rh BNP group and the control group the ICU 54 ± 14 hours,respectively,61±16 hours,which is t=2.33,P<0.05,the difference was statistically significant;The two groups in the hospital total time of 9±2.4days respectively,10±1.3 days,which is t=2.59,P<0.05,the difference was statistically significant.Conclusions: Postoperative application of rh BNP OPCABG can obviously improve cardiac function in patients with;The total time can shorten the postoperative care and be in hospital;Application of rh BNP safe and reliable;To rise and fall of cardioascular events has no obvious effect. |
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