体外循环与非体外循环下冠状动脉旁路移植术的围术期效果及远期预后比较研究

发布时间：2018-04-10 08:11

本文选题：冠状动脉旁路移植术　切入点：体外循环　出处：《中国全科医学》2017年25期

【摘要】：目的比较体外循环下冠状动脉旁路移植术(ONCAB)和非体外循环下冠状动脉旁路移植术(OPCAB)的围术期效果及远期预后。方法选取1998年11月—2009年12月在广东省中医院大学城医院心血管二科行单纯ONCAB的患者97例,为ONCAB组;另选取同期在本科行单纯OPCAB的患者150例,为OPCAB组。收集并比较两组患者的基线资料、围术期资料及随访资料。结果 OPCAB组患者年龄高于ONCAB组,左主干病变发生率低于ONCAB组,差异有统计学意义(P0.05)。OPCAB组患者远端吻合口数少于ONCAB组,手术时间及术后机械通气时间、入住ICU时间、住院时间短于ONCAB组,术后多巴胺用量、红细胞用量、血浆用量及术后引流量少于ONCAB组,差异有统计学意义(P0.05)。两组患者住院死亡率比较,差异无统计学意义(P0.05)。围术期存活的242例患者中,172例(71.1%)随访7年以上,平均随访时间为(11.6±2.5)年。OPCAB组随访7年以上患者胸闷/心绞痛症状发生率、新发ST-T改变/心律失常率、血管桥闭塞发生率高于ONCAB组,差异有统计学意义(P0.05);但二者因心脏事件死亡率、因心脏外事件死亡率及总死亡率比较,差异无统计学意义(P0.05)。结论 OPCAB的围术期康复效果明显优于ONCAB;但OPCAB因操作较困难导致远期桥血管通畅率较差,再发胸闷/心绞痛率、新发心肌缺血性改变率较高。
[Abstract]:Objective to compare the perioperative effect and long-term prognosis of coronary artery bypass grafting (ONCAB) and off-pump coronary artery bypass grafting (OPCAB) under cardiopulmonary bypass (CPB).Methods from November 1998 to December 2009, 97 patients who received ONCAB in Department of Cardiovascular, University City Hospital of Guangdong traditional Chinese Medicine Hospital were selected as ONCAB group, and 150 patients who were treated with OPCAB as OPCAB group in the same period.Baseline data, perioperative data and follow-up data were collected and compared between the two groups.Results the age of patients in OPCAB group was higher than that in ONCAB group, and the incidence of left main lesion was lower than that in ONCAB group. The number of distal anastomosis in OPCAB group was lower than that in ONCAB group. The operation time, postoperative mechanical ventilation time and ICU stay time were lower in OPCAB group than in ONCAB group.The hospitalization time was shorter than that in ONCAB group, and the dosage of dopamine, erythrocyte, plasma and postoperative drainage volume were less than those in ONCAB group, and the difference was statistically significant (P 0.05).There was no significant difference in hospital mortality between the two groups (P 0.05).The average follow-up time was 11.6 卤2.5) years. The incidence of chest tightness / angina pectoris, the rate of new ST-T change / arrhythmia, the incidence of vascular bridge occlusion were higher in the OPCAB group than in the ONCAB group.The difference was statistically significant (P 0.05), but there was no significant difference between the two groups due to cardiac events, extracardiac events and total mortality.Conclusion the perioperative rehabilitation effect of OPCAB is obviously better than that of ONCAB.However, because of the difficulty of operation, the long-term graft patency rate of OPCAB is poor, the rate of recurrent chest tightness / angina pectoris is higher, and the rate of newly developed myocardial ischemia is higher.
【作者单位】：广东省中医院大学城医院心血管二科;
【基金】：广东省科技计划项目(2014A020212271)
【分类号】：R654.2

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