关键词: 不停跳冠状动脉搭桥术, 心肌灌注, 微循环, 影响因素

Abstract: Objective  Exploring the factors associated with the recovery of early myocardial microcirculatory perfusion after OPCABG.Methods  Retrospective analysis of 100 patients treated with OPCABG in the department of cardiovascular surgery from June 2019 to February 2021.Patients were divided into two groups according to the recovery of myocardial perfusion in each segment in the early postoperative period.Group A:76 patients with improved perfusion in all segments and Group B:24 patients with poor perfusion improvement left in some segments.We compared the pre-procedure gender composition,age,BMI,hypertension,diabetes,dyslipidaemia,smoking,alcohol consumption,metabolic disease,history of PCI,cTnI-T,BNP and cardiac echocardiography results between the two groups.Results  Age[(71.63±5.09)y vs.(64.74±9.45)y],BMI[(29.27±3.56)kg/m² vs.(26.09±3.08)kg/m²],prevalence of diabetes(87.5% vs.21.1%) and incidence of dyslipidemia(70.8% vs.9.2%) were significantly higher in Group B than in Group A,and the difference was statistically significant(P<0.05).No statistically significant differences were seen in the gender composition,prevalence of hypertension,smoking,alcohol consumption,prevalence of metabolic disease,history of PCI,cTnI-T,BNP and cardiac structure between the two groups(P>0.05).Logistic regression modelling showed that age(OR:1.240,95%CI:1.080-1.486),prevalence of diabetes(OR:0.086,95%CI:0.014-0.391) and the occurrence of dyslipidaemia(OR:0.047,95%CI:0.007-0.220) were risk factors for poor improvement of the residual segment in the early postoperative period after OPCABG,and that they were good predictors(AUC=0.934,P<0.001).No significant coefficients were seen between age,dyslipidemia,history of diabetes and BMI(P>0.05). Conclusion  Age,history of diabetes and dyslipidaemia as risk factors for predicting improvement in myocardial microcirculatory perfusion after OPCABG.They can predict the improvement of microcirculation in the early postoperative period in OPCABG patients with high sensitivity and specificity.  

Key words: off-pump coronary artery bypass graft, myocardial perfusion, microcirculation, influencing factors