| Objective: Coronary atherosclerotic heart disease(CHD)is one of the most common causes of death in humans.In the later 20 years,with the morbidity and mortality of coronary heart disease further increasing in China,the age of patients tend to younger and younger.The therapy of coronary heart disease aims to restore myocardial blood supply and reduce or alleviate the symptoms so that improve the quality of life and extend the longevity of patients.There are three main methods could be adopted,including medicine therapy,Percutaneous Coronary Intervention(PCI)and surgical.The progress of surgical,especially coronary artery bypass grafting(CABG),is particularly rapid.Both of the basic treatment and care of postoperative patients were the key to surgery and prognosis.It’s significant of the value of lyophilized recombinant human brain natriuretic peptide(trade name is new activator)and it has become a new medicine for the cure of acute left heart failure which is a synthetic endogenous hormone in recent years.The medicine could dilate blood vessels effectively,diuretic sodium and reduce both preload and afterload of cardiac as well as improve the hemodynamic obstacle of acute heart failure in patients.Recent studies have shown that freeze-dried recombinant human brain natriuretic peptides also benefit to the patients who undergoing cardiac surgery,whether the medicine play a role in patients who undergoing coronary artery bypass grafting remains inconclusive.We know little about the effect of freeze-dried recombinant human brain natriuretic peptide after coronary artery bypass grafting in China.To observe the effect of left ventricular function and left ventricular remodeling in postoperative patients,so as to provide new ideas and directions for the application of freeze-dried recombinant human brain natriuretic peptide after CABG and guide the basic treatment and care of patients after CABG.Methods: Choose patients who suffer off-pump CABG(OPCABG)February 2016 to December 2016 in Hebei Medical University randomly.The criteria were as follows: 1.Diagnosis of CHD-chronic myocardial infarction;2.Preoperative diagnosis(Left ventricular Ejection Fractions,LVEF)less than 50% of the patients;3.Patients and their families informed and signed consent to receive elective CABG treatment,and successful operation.Exclude patients that combine with other operations,such as combined with valvular surgery or congenital heart disease surgery;accompany with severe liver and kidney dysfunction,clear freeze-dried recombinant human brain natriuretic peptides;along with lower Systolic blood pressure <90mm / Hg)and it was not improve after active treatment.A total of 44 patients were enrolled,and the basic baseline data such as patients data,medical records and clinical features,preoperative and postoperative laboratory tests,imaging data and revascularization were recorded in detail,and investigated follow-up by telephone and outpatient,during the follow-up period mainly asked patients to review the heart after the echocardiography(UCG),electrocardiogram(ECG)and whether the occurrence of cardiovascular and cerebrovascular events after discharge.After OPCABG,patients were sent to the intensive care unit(ICU)and divided into two groups(n = 22)randomly.Group 1 was supplied with freeze-dried recombinant human brain natriuretic peptide,and the group 2 was none.Two groups of patients were given conventional treatment after surgery(cardiac,diuretic,vasodilator,etc.).Patients in group 1 were cured with freeze-dried recombinant human brain natriuretic peptide by intravenous pump after operation immediately and lasting for 72 hours.All patients underwent echocardiography at 5 days before operation,5 days and a month after operation and compared the changes of echocardiographic parameters between the two groups.The time of stay in ICU,troponin values in first 24 hours after operation and whether occur adverse cardiovascular and cerebrovascular events or not,such as recurrent angina,recurrent myocardium Infarction,revascularization,stroke,re-admission treatment and so on.According to the purpose of this study,the data tables are compiled and the relevant indexes are statistically analyzed.The data are compiled and summarized according to the principles and methods of statistical experiment design.SPSS19.0 statistical software is used to analyze and analyze the data and establish statistical tables.P <0.05 was considered to be statistically significant,and the differences between the data were found to be statistically different.The statistical data of the relevant data were analyzed and discussed,and the guidance for clinical medication was provided.Results:1 Differences in basal data such as age;gender;history of hypertension,diabetes mellitus,hyperlipidemia,previous smoking and previous drinking;number of bypass,LVEF,LVEDV,LV(P> 0.05).There was no significant difference between the two groups(P> 0.05),and the data were comparability.2 The left ventricular ejection fraction of the group 1 was significantly higher than that of the group 2(P <0.001)both in five days after surgery and one month after discharge.The left ventricular ejection fraction was significantly higher than that in the group 2.3 The Left Ventricular End-diastolic Volume(LVEDV)and the Left Ventricle(LV)of the two groups were not statistically significant(P> 0.05)in five days after surgery.But the LV and the LVEDV in group 1 were significantly lower(P <0.05)than those in the group 2 in one month after discharge.4 Cardiac Troponin can be used as a reflection of myocardial cell damage in one of the serum markers,by the serum c Tn I(clinical examination of the most commonly used myocardial muscle calcium Protein subunits)to assess the severity of heart disease [1-2],also through c Tn I to reflect the degree of myocardial injury after CABG,the group 1 and group 2 in 24 hours after the c Tn I value(P <0.05),and the difference was statistically significant(P <0.05)in the group 1 compared with the group2.5 Because of the particularity and risk of cardiac surgery,patients undergoing CABG were observed immediately after ICU observation(such as heart rate,blood pressure,central venous pressure(CVP),mental state,etc.)can be transferred to the general ward after the stability.(P <0.05).The number of hours remaining in the neonatal group was significantly lower than that in the untreated group(P <0.05),and the time of stay in the ICU group was significantly lower than that in the untreated group Non-activin group.6 Because the selected sample size is small,the patient is discharged after the occurrence of myocardial infarction,recurrent angina,stroke,re-admission treatment,etc.were not statistically significant,still need to expand the sample size and long-term further observation and study.Conclusions:1 Intravenous application of freeze-dried recombinant human brain natriuretic peptide can make CABG patients after left ventricular ejection fraction increased,improve myocardial contractility,improve left ventricular function.2 Intravenous application of freeze-dried recombinant human brain natriuretic peptide can significantly alleviate the occurrence of long-term left ventricular remodeling after CABG in patients with old myocardial infarction and improve the prognosis of patients with coronary artery bypass grafting.3 Intravenous application of freeze-dried recombinant human brain natriuretic peptide in patients in first 24 hours after cardiac troponin was significantly less than ordinary patients with basic treatment,to reduce the damage of myocardial cells in patients with clinical significance.4 Intravenous application of freeze-dried recombinant human brain natriuretic peptide in ICU stay more time than ordinary patients with basic treatment to shorten the recovery of patients with clinical time has clinical significance. |
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