择期“分站式”冠状动脉血运杂交重建治疗冠状动脉多支病变

发布时间：2018-11-02 11:10

【摘要】：目的探讨择期"分站式"冠状动脉血运杂交重建(hybrid coronary revascularization,HCR)治疗冠状动脉多支血管病变的安全性、可行性。方法选取2012年5月~2014年8月在我院行择期"分站式"冠状动脉血运杂交重建的73例资料,以同期、同一术者完成的择期非体外循环冠状动脉旁路移植术(off-pump coronary artery bypass,OPCAB)383例作为对照,进行回顾性研究。2组一般资料差异无显著性。比较2组围术期及随访结果。结果与OPCAB组相比,HCR组手术时间短[(152.9±43.8)min vs.(262.6±51.8)min,t=-16.993,P=0.000],术后总引流量少[中位数460(20~2070)ml vs.980(130~8770)ml,Z=-8.232,P=0.000],输血少[12例(16.4%)vs.200例(52.2%),χ2=31.555,P=0.000],机械通气时间短[(9.4±7.4)h vs.(19.0±18.3)h,t=-4.391,P=0.000]。术后HCR组随访73例(100%),OPCAB组随访360例(94.0%)。2组随访时间差异无显著性[(25.0±9.6)月vs.(22.8±10.6)月,t=1.693,P=0.091]。2组主要心脑血管不良事件(major adverse cardiac or cerebrovascular events,MACCE)发生率无显著性差异[4例(5.5%)vs.10例(2.8%),χ~2=0.684,P=0.408],生存曲线也无显著性差异(log-rankχ~2=1.041,P=0.308)。结论 "分站式"冠状动脉血运杂交重建术与OPCAB相比手术时间短,引流量少,输血少,机械通气时间短,随访结果显示其MACCE发生率与OPCAB相近。因此认为,"分站式"冠状动脉血运杂交重建术是一种安全、有效的手术方式。
[Abstract]:Objective to investigate the safety and feasibility of selective "sub-station" coronary artery hybridization reconstruction (hybrid coronary revascularization,HCR) in the treatment of coronary artery disease. Methods from May 2012 to August 2014, 73 patients underwent selective "sub-station" coronary artery revascularization in our hospital. The patients underwent elective off-pump coronary artery bypass grafting (off-pump coronary artery bypass,) during the same period. A retrospective study was conducted in 383 cases of OPCAB. There was no significant difference in general data between the two groups. The perioperative and follow-up results were compared between the two groups. Results compared with OPCAB group, HCR group had shorter operation time [(152.9 卤43.8) min vs. () 262.6 卤51.8 min,t=-16.993,P=0.000] and less total postoperative drainage [median of 460 (20 卤2070) ml vs.980 (130 卤8770) ml,Z=-8.232,]. There were 12 cases (16.4%) with vs.200 (52.2%), with short mechanical ventilation time (9.4 卤7.4) h vs. (19.0 卤18.3), with short mechanical ventilation time (9.4 卤7.4) h vs. (19.0 卤18.3). 73 cases (100%), OPCAB) were followed up in the HCR group (94.0%). There was no significant difference in the follow-up time between the two groups [(25.0 卤9.6) months vs. (22.8 卤10.6) months, t = 1.693. There was no significant difference in the incidence of major cardiovascular and cerebrovascular adverse events (major adverse cardiac or cerebrovascular events,MACCE) between the two groups (4 cases (5.5%), vs.10 cases (2.8%), 蠂 ~ 2 + 0.684%, P < 0.408), and there was no significant difference between the two groups in the incidence of major cardiovascular and cerebrovascular adverse events. There was also no significant difference in survival curve (log-rank 蠂 ~ 2 ~ (1.041) P ~ (0.308). Conclusion compared with OPCAB, the "sub-station" coronary artery revascularization has shorter operation time, less drainage, less blood transfusion and shorter mechanical ventilation time. The follow-up results show that the incidence of MACCE is similar to that of OPCAB. It is considered that the branch-by-station coronary artery hybrid reconstruction is a safe and effective method.
【作者单位】：北京大学第三医院心脏外科;北京大学第三医院心脏内科;
【分类号】：R654.2

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