环氧二十碳三烯酸、N端脑钠肽前体、肌钙蛋白与冠状动脉旁路移植术后早期并发症的关系研究

易铭; 李晓红; 张从利; 杨传铭; 武若杰; 刘睿

doi:10.13898/j.cnki.issn.2097-5252.2025.04.005

环氧二十碳三烯酸、N端脑钠肽前体、肌钙蛋白与冠状动脉旁路移植术后早期并发症的关系研究

Relationship between epoxyeicosatrienoic acid, N-terminal brain natriuretic peptide precursor and troponin in early complications after coronary artery bypass grafting

摘要

摘要:
目的探讨环氧二十碳三烯酸(EET)、N端脑钠肽前体(NT-proBNP)、肌钙蛋白(cTnI)与冠状动脉旁路移植术(CABG)后早期并发症的关系。
方法选取全麻体外循环下行CABG病人作为研究对象, 根据术后有无并发症分为并发症组(n=39)和无并发症组(n=66), 记录病人术前EET、基础资料、术中体外循环时间、升主动脉阻断时间、移植血管数以及术后24、48、72 h的NT-proBNP、cTnI水平。
结果并发症组病人年龄、体质量指数均高于无并发症组(P < 0.05), 并发症组病人左心室射血分数、14, 15-EET水平低于无并发症组(P < 0.05), 并发症组的体外循环时间、阻断时间和术后ICU停留时间均高于无并发症组(P < 0.05)。2组血清NT-proBNP、cTnI水平在不同时间点差异均有统计学意义(P < 0.01)；并发症组术后24、48、72 h的血清NT-proBNP、cTnI水平均高于无并发症组(P < 0.01)。14, 15-EET是体外循环下CABG发生术后并发症的危险因素(P < 0.01)。14, 15-EET预测术后早期并发症发生AUC为0.772(95%CI：0.682~0.863), 临界值为49.05 μg/L, 灵敏度为78.8%, 特异度为64.1%。24 h的cTnI水平与14, 15-EET水平呈显著负相关关系(r=-0.253, P < 0.05)。
结论 CABG病人术前血清低EET水平与并发症发生有关, 术前血清EET水平对术后早期并发症有预测价值, 术后不同时间NT-proBNP、cTnI可以为病人的预后进行早期评估。

Abstract:
Objective To investigate the relationship between epoxyeicosatrienoic acid (EET), N-terminal brain natriuretic peptide precursor (NT-proBNP) and troponin (cTnI) in the early complications after coronary artery bypass grafting (CABG).
Methods Patients undergoing CABG under general anesthesia with extracorporeal circulation were selected as study subjects and divided into complication group (n=39) and non-complication group (n=66) according to the presence or absence of postoperative complications, and patients' preoperative EET, basal data, intraoperative extracorporeal circulation time, ascending aortic block time, number of graft vessels, and NT-proBNP and cTnI levels at 24, 48, and 72 h after operation were recorded.
Results The age and body mass index of patients in the complication group were higher than those in the non-complication group (P < 0.05).The left ventricular ejection fraction, 14, 15-EET levels in the complication group were lower than those in the non-complication group (P < 0.05).The extracorporeal circulation time, blocking time, and postoperative ICU stay time in the complication group were higher than those in the non-complication group (P < 0.05).The levels of serum NT-proBNP and cTnI in the two groups showed statistical significance at different time points (P < 0.01).The serum NT proBNP and cTnI levels in the complication group were higher than those in the non-complication group at 24, 48, and 72 h after surgery (P < 0.01).14, 15-EET was a risk factor for postoperative complications of CABG under cardiopulmonary bypass (P < 0.01).The AUC for predicting early postoperative complications using 14, 15-EET was 0.772 (95%CI: 0.682-0.863), with a critical value of 49.05 μg/L, sensitivity of 78.8%, and specificity of 64.1%.The 24-hour cTnI level showed a significant negative correlation with the levels of 14, 15-EET (r=-0.253, P < 0.05).
Conclusions Low preoperative serum EET levels in CABG patients are associated with the occurrence of complications, and preoperative serum EET levels have predictive value for early postoperative complications, and NT-proBNP and cTnI at different postoperative times can provide an early assessment of patient prognosis.

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