常规与非体外循环冠状动脉旁路移植术治疗冠状动脉多支病变的对比分析

目的　评价非体外循环下冠状动脉旁路移植术 (OPCAB)与常规体外循环下冠状动脉旁路移植术(CCABG)相比是否具有优越性。　方法　将 170例 2支以上血管病变行冠状动脉旁路移植术 (不包括瓣膜手术或室壁瘤切除等合并手术的病例 )患者分为 OPCAB组和 CCABG组 ,OPCAB组通过胸骨正中切口 ,在非体外循环心脏不停跳下完成冠状动脉旁路移植术 ;CCABG组建立常规体外循环 ,心脏停搏下完成冠状动脉旁路移植术。对两组病例的术前和术后各项指标进行对比分析。　结果　两组患者术前的一般情况无差异 ,OPCAB组与 CCABG组间曾行溶栓或经皮腔内冠状动脉成形术治疗和 3支病变的比例分别为 31.8%比 18.3%和 5 9%比 78% ,移植旁路血管分别为3.6± 0 .8支比 4.3± 1.0支 (P<0 .0 1) ,但所用的血管材料两组间无差异。OPCAB组术后呼吸机辅助时间和外科住院时间较短 ,住院费用较低 (P<0 .0 5 )。但术后并发症如二次开胸止血、伤口感染、心律失常、围术期心肌梗死、肺部并发症等的发生率 OPCAB组为 9.8% ,CCABG组为 14.6 % ;OPCAB组无手术死亡 ,CCABG组死亡 1例 (P>0 .0 5 )。　结论　 OPCAB治疗冠心病多支病变的初期结果显示可以减少患者术后辅助呼吸时间和外科住院时间 ,降低住院费用。但目前尚不能替代 CCABG,其近、远期效果仍     

心脏不停跳非体外循环冠状动脉旁路移植术的进展

近年来，随着手术器械的发展，心脏不停跳非体外循环下冠状动脉旁路移植术(OPCAB)逐渐被广泛接受和应用。与常规冠状动脉旁路移植术(CCABG)比较，OPCAB的主要优势为血液中多种炎性介质浓度明显降低，避免了体外循环(CPB)带来的全身系统性炎性损害，减少了并发症，降低了手术死亡率。特别对那些不能采用CPB或采用CPB有风险的高危患者优势更明显。CCABG的手术适应证同样适用于OPCAB，但OPCAB具有相对的禁忌证。OPCAB多采用胸骨正中切口，左前外侧切口适用于左前降支单支病变。OPCAB术后早期结果类似CCABG，但中远期结果有待进一步观察。OPCAB大多数旁路移植血管数低于CCABG，有不能完全再血管化的可能，对OPCAB是否会影响吻合的精确性和旁路血管的长期通畅率有不同意见。OPCAB的优势明确，但仍不能完全替代CCABG，手术的同时应作好CPB准备，必要时改行CCABG。     

70岁以上病人非体外循环与常规冠状动脉旁路移植术比较

目的　探讨 70岁以上老年病人非体外循环冠状动脉旁路移植术 (OPCAB)的疗效。方法　比较 78例 70岁以上OPCAB和 32例 70岁以上常规体外循环冠状动脉旁路移植术 (CCABG)的临床资料。结果　两组术后桥通畅率均为 10 0 % ,OPCAB和CCABG两组平均住院时间 (9 2 5± 4 0 3)d对(13 18± 7 5 4)d ,平均ICU时间 (2 4 0± 8 5 )h对 (38 5± 2 5 5 )h ,房颤发生率为 8%对 15 %。结论　老年病人有选择的施行OPCAB是一种合理和安全的术式 ,如果可能的话应尽量考虑采用此术式。     

非体外循环与常规冠状动脉旁路移植术后心肌酶的动态变化

目的通过观察非体外循环冠状动脉旁路移植术(OPCAB)与常规冠状动脉旁路移植术(CCABG)患者术后心肌肌钙蛋白I(cTnI)和肌酸激酶同工酶(CK-MB)的动态变化,比较两种手术方式对心肌的损伤情况.方法102例不稳定型心绞痛患者,按不同的手术方式分为OPCAB组和CCABG组.OPCAB组:71例,行OPCAB;CCABG组:31例,行CCABG.两组分别于术前、术后4、12小时、1、3、5天测定cTnI和CK-MB.结果CCABG组行旁路血管移植2～5支(2.97±0.84支),OPCAB组1～5支(2.69±0.92支);两组均无围术期心肌梗死.两组术后早期cTnI和CK-MB均有升高,分别于术后5天和术后3天基本恢复至术前水平.术后4、12小时、术后1天OPCAB组cTnI值与CCABG组比较差别有显著性意义(P<0.01).结论有选择的施行OPCAB是一种安全和合理的手术方式,OPCAB的心肌损伤程度明显轻于CCABG.     

糖尿病病人行OPCAB与CCABG的早期结果对比

目的 比较糖尿病病人非体外循环和经典体外循环冠状动脉旁路移植(OPCAB和CCABG)的术后早期临床结果.方法 1999年4月至2008年1月,318例糖尿病病人行冠状动脉旁路移植术(CABG).OPCAB 210例,CCABG 108例.两组术前总体情况差异无统计学意义.OPCAB在非体外循环、心脏跳动下完成,CCABG在体外循环、心脏停跳下完成.正中开胸,胸膜外游离带蒂左乳内动脉(LIMA),与左前降支(LAD)吻合,大隐静脉(GSV)与其他靶血管吻合,吻合口超过2个采用序贯吻合.术前口服降糖药或皮下注射胰岛素将血糖控制在6 mmol/L以下,术后早期在ICU时持续泵入胰岛素,将血糖控制在6～8mmol/L.结果 两组共5例(1.57%)死亡,7例(2.20%)发生并发症.两组均达到完全再血管化,平均移植旁路血管OPCAB组(2.6±1.1)支,低于CCABG组的(3.1±1.3)支,P＜0.05.OWCAB组死亡1例(0.48%),明显低于CCABG组4例(3.70%),P＜0.05.OPCAB组发生并发症5例(2.30%),CCABG组2例(1.85%),组间差异无统计学意义,P＞0.05.结论 糖尿病者冠状动脉旁路移植手术围术期严格控制血糖至接近正常水平,住院病死率和并发症率低.OWAB术后早期病死率明显低于CCABG.     

非体外循环心脏跳动下冠状动脉旁路移植术桥血流的研究

目的　术中测量非体外循环心脏跳动下冠状动脉旁路移植术 (OPCAB)桥血管的血流量和搏动指数 (PI)及血流波形 ,以探讨血管桥通畅率及其与波形的关系。方法　 2 34例病人接受OPCAB手术 ,采用左乳内动脉 (LIMA)全部与左前降支 (LAD)吻合 ,大隐静脉 (SV)吻合口在 2个以上采用序贯式吻合。术中用超声血流检测仪 (medi stimbutterflyflowmeter)测量旁路血管桥的血流量、PI值及其波形 ,根据结果判断桥路通畅情况 ,并且对比LIMA和SV旁路血管桥的血流量和LIMA中LAD近段狭窄大于 90 %与小于 90 %者的血流量。结果　LIMA使用率 10 0 % ,LIMA和SV桥通畅率 10 0 % ,LIMA平均血流量(19 99± 1 93)ml/min ,SV血流量 (38 17± 2 85 )ml/min ,两者差异显著 (P <0 0 1)。LIMA组中LAD近段狭窄大于 90 %者血流量 (32 0 0± 3.4 0 )ml/min ,小于 90 %者血流量 (15 2 9± 1 6 6 )ml/min ,两者差异显著(P <0 0 1)。PI平均值LIMA为 3 2 9± 0 2 2 ,SV为 3 4 1± 0 37。术后病人无并发症 ,心绞痛消失 ,全部治愈出院 ,平均住院 (7 0± 1.5 )d。随访无死亡。结论　OPCAB术吻合口的通畅率令人满意 ,静脉桥血流量高于LIMA ;LAD近段狭窄大于 90 %时LIMA血流量较高。反映桥通畅的最可靠指标是桥血流的搏动指数 ,而舒张期血流的波     

体外循环与非体外循环下冠状动脉旁路移植术移植血管流量对比分析

目的比较非体外循环下冠状动脉旁路移植术(off-pump coronary artery bypass graft,OPCABG)与传统体外循环下冠状动脉旁路移植术(conventional on-pump coronary artery bypass graft,CCABG)移植血管通畅性。方法利用瞬时血流测定技术(transit-time flow meter,TTFM)对105例CCABG和140例OPCABG移植血管进行测量,并记录平均流量(mean flow,Qm)及搏动指数(pulsatility index,PI)。结果2组一般情况无显著性差异,2组旁路移植血管数目及血管材料无差异。流量测定结果,乳内动脉OPCABG组(n=101)Qm(37.2±26.6)ml/min,PI3.3±1.3;CCABG组(n=75)Qm(39.5±21.8)ml/min,PI3.3±1.2,两组差异无显著性(t=-0.612、0.000,P>0.05),大隐静脉流量两组也无显著性差异[OPCABG组(n=335)Qm(36.8±27.4)ml/min,PI3.1±1.5;CCABG组(n=281)Qm(40.9±...     

序贯式旁路移植术在非体外循环冠状动脉旁路移植术中的应用

目的总结非体外循环下序贯式旁路移植术治疗冠状动脉粥样硬化性心脏病的临床疗效。方法 26例冠心病患者接受非体外循环下冠状动脉旁路移植术,采用序贯式吻合移植技术。术中采用即时血流测量仪评价桥血管通畅情况。结果 26例患者共搭桥83支,平均3.19支,其中搭4支桥患者5例。术中无中转体外循环,术中测量序贯桥血管主干流量(45.56±9.23)m L/min,搏动指数(PI)3.56±0.66;测量终末桥血管流量(16.15±5.09)m L/min,搏动指数(PI)3.02±0.24。术后随访26例患者1年内均未出现心绞痛症状,患者心电图及心脏超声较术前均有所改善。结论非体外循环下序贯式旁路移植术治疗冠心病安全、有效、近中期疗效满意,是治疗冠心病多支病变患者的有效方法。     

70岁以上冠状动脉旁路移植术病人乳内动脉流量测量分析

目的 分析70岁以上冠状动脉旁路移植术病人乳内动脉旁路血管血流量的特点.方法 对2003年1月至2007年1月间78例70岁以上(含70岁)应用乳内动脉非体外循环冠状动脉旁路移植手术(OPCAB)的病人,使用瞬时超声血流测量技术对其乳内动脉平均血流量、搏动指数等指标进行测量并分析.结果 78例病人83根乳内动脉旁路血管平均流量(36.0±21.5)ml/min,平均搏动指数3.50±1.76,血流波形均以舒张期为主.男女性别比、平均流量和搏动指数差异无统计学意义[(39.0±23.1) ml/min对(28.0±14.7) ml/min;(3.30±1.50)对(4.10±2.22),P>0.05],但女病人平均流量较男病人偏低,搏动指数较男病人偏高.结论 70岁以上病人冠状动脉旁路移植术应用乳内动脉是安全、有效的;对老年病人乳内动脉流量的评价分析应当结合老年病人的病变特点.     

OPCAB即时与关胸时乳内动脉桥血流的对比研究

目的　使用即时超声血流探测仪对比观察非体外循环冠状动脉旁路移植术 (OPCAB)术中左乳内动脉 (LIMA)桥吻合完毕当时 (早期 )与关胸时 (晚期 )桥血流变化规律。方法　 2 0 0 2年 1月至 8月 ,对 6 5例OPCAB病人进行了早期与晚期动脉桥血流的对比研究。其中男 5 0例 ,女 15例 ;年龄 47～ 75岁 ,70岁以上病人 19例 ( 2 9 2 %)。病人均为不稳定型心绞痛 ,其中冠状动脉三支病变 32例 ( 49 2 %) ,二支病变 2 6例 ( 40 0 %) ,单支病变 7例 ( 10 8%)。OPCAB术中常规使用LIMA与左前降支 (LAD)吻合。于LIMA与LAD吻合完毕和手术结束关胸前 ,用即时血流测量仪 (transit timeflowmeter)直接测量并记录LIMA桥血流波形、平均流量、舒张期流量、收缩期流量、搏动指数及平均动脉压。结果　两组平均动脉压差异无显著性 (P =0 0 5 ) ;LIMA桥平均血流量早期 ( 2 9 91± 3 32 )ml min显著高于晚期 ( 2 5 12± 2 5 6 )ml min ,P =0 0 3;舒张期流量早期 ( 5 9 2 6± 5 2 1)ml min与晚期 ( 5 4 36± 4 2 7)ml min差异无显著性 ,P =0 0 8;收缩期流量早期 ( 12 98± 1 6 4)ml min显著高于晚期 ( 6 17± 1 93)ml min ,P <0 0 0 1;搏动指数早期 2 6 9± 0 12明显小于晚期 3 36± 0 37,P =0 0 2。结论　LIMA与LAD吻合     

非体外循环与体外循环冠状动脉旁路移植血管中远期通畅率比较

目的 比较非体外循环不停跳与体外循环冠状动脉旁路移植手术后中远期移植血管的通畅率.方法 对同一术者行冠状动脉旁路移植手术后5年以上病例50例.按手术方式分为两组.第1组采用传统体外循环下进行冠状动脉旁路移植(体外循环组,25例);第2组采用非体外循环不停跳技术进行冠状动脉旁路移植(非体外循环组,25例).对所有病例进行冠状动脉造影随访,比较两组移植血管的通畅情况.结果 两组均男21例,女4例.第1组手术年龄(55.4±8.9)岁;随访70～110个月,平均(86.52±12.48)个月;移植血管共83支,其中动脉移植血管41支,静脉移植血管42支,平均移植血管(3.32±0.63)支/例;随访移植血管通畅61支,狭窄6支,闭塞16支,动脉移植物通畅率为78.05%,静脉通畅率69.05%,总通畅率73.49%.第2组手术年龄(58.2±9.09)岁;移植血管共65支,其中动脉移植血管31支,静脉移植血管34支,平均移植血管(2.52±0.71)支/例,随访64～99个月,平均(82.68±12.48)个月;随访移植血管通畅47支,狭窄4支,闭塞14支,动脉移植物通畅率为74.19%,静脉通畅率70.59%,总通畅率72.31%.结论 非体外循环不停跳冠状动脉旁路移植手术移植血管中远期通畅率与传统体外循环手术一致,均可达到较好的中远期疗效.

Abstract：

Objective Off-pump coronary artery bypass grafting (OPCAB) is used more widely in recent years in China. However, there is an argument on benefits and risks of off-pump surgery. Many studies shown that OPCAB had more benefits in short-term outcomes than conventional coronary artery bypass grafting(CCABG). But evidences from other studies suggested that OPCAB resulted in less long-term graft patency as compared with on-pump surgery. This study examined the longterm graft patency of OPCAB and CCABG performed by one surgeon. Methods 50 patients who had received surgical revascularization by a surgeon for more than 5 years were reviewed, 25 patients received conventional coronary artery bypass grafting ( group 1 ) and 25 patients received OPCAB ( group 2). All patients had angiograms for compareing the graft patency between the two groups. Results Among 25 patients in group 1,21 were male and 4 were female. The mean age of patients at surgery was (55.4 ±8.9) years. 15 cases had unstable angina, 16 patients had old myocardial infarction and 6 cases had diabetes.The ejection fraction (EF) was 0.58 ±0.14. The mean number of bypasses per patient was 3.32 ±0.63. Mean duration of operation was (3.58 ± 0. 82) hours. Mean follow-up duration was ( 86.52 ± 12.48) months. 83 grafts were evaluated for patency ( open vs. closed) and were graded by Fitzgibbon as grade A ( excellent graft), B ( impaired graft, with a stenosis of ≥50%, or a diameter less than 50% of the grafted artery), or O ( completely occluded). The graft patency was 73.49%, 61grafts were graded as Fitzgibbon A, 6 grafts as Fitzgibbon B and 16 grafts as Fitzgibbon 0. 25 patients were in group 2, 21males and 4 females. The mean age of patients at procedure was (58.2 ± 9.09) years, 11 patients had unstable angina, 13 patients had old myocardial infarction and 6 cases had diabetes. The ejection fraction (EF) was 0.59 ± 0. 14. Conclusion No 2011.03.013 difference in long-term graft patency was identified between on-pump and off-pump coronary artery bypass grafting. Off-pump oronary artery bypass grafting preformed by an experienced surgeon may gain similar long-term graft patency to that of conventional bypass.     

The impact of intraoperative transit time flow measurement on the results of on-pump coronary surgery.

OBJECTIVE: The purpose of this study is to evaluate the effect of detection of graft dysfunction by intraoperative transit time flow measurement (TTFM) on the surgical results of on-pump coronary artery bypass grafting. METHODS: Two hundred patients undergoing on-pump isolate coronary artery bypass grafting via median sternotomy performed by the same surgical team were included into the study. TTFM was routinely performed for assessment of graft patency during operation after a transit time flow meter became available in our center in February 2006. The last 100 consecutive patients before this date formed the control group (Group A), and the first 100 consecutive patients after this date formed the study group (Group B). Interpretation of the values obtained using the TTFM in Group B patients has allowed us to reach a decision whether or not to revise a graft. Preoperative and postoperative variables of the two groups were compared. RESULTS: The clinical features of control and study groups were comparable. We assessed patency of 303 grafts using TTFM. Revision was required for nine grafts in nine patients based on unsatisfactory TTFM findings. Incidences of overall mortality (p<0.05), peri- or postoperative myocardial infarction (p<0.05) and intraaortic balloon pump insertion (p<0.05) were significantly lower in Group B than Group A. CONCLUSIONS: We believe that TTFM seems to be a crucial tool for deciding if a graft is well-functioning or not, and it allows for improvement of graft failure during operation. Our results suggest that detection of graft dysfunction intraoperatively by TTFM improves the surgical outcome.     

The correlation between flow pattern during cardiopulmonary bypass and patency of the coronary artery bypass grafts

Recently the availability of transit time flow measurement (TTFM) is reported especially in off-pump coronary artery bypass grafting (CABG). But little is known about TTFM findings in on-pump CABG. We examined the correlation between the TTFM flow pattern and the angiography findings in on-pump CABG. The subjects consisted of 52 patients who underwent on-pump CABG and angiography early after operation. In these patients, 55 internal thoracic artery (ITA), 17 gastroepiploic artery (GEA), 13 saphenous vein graft (SVG) and 41 radial artery (RA) were tested with TTFM during cardiopulmonary bypass (CPB). TTFM demonstrated a diastolic filling pattern in 53 ITA, 16 GEA, 13 SVG and 36 RA. The angiography revealed that all these grafts were perfectly patent with the exception of a GEA with a flow competition pattern. TTFM revealed an abnormal flow pattern in 2 ITA (these 2 grafts were revised during CPB and the angiography demonstrated their perfect patency), 1 GEA (to and fro pattern), 0 SVG and 5 RA (the abnormal pattern was due to graft spasm in 3 of 5, and the angiography revealed their perfect patency, however, the angiography detected stenosis in the remaining 2 grafts). The present study found that the TTFM flow pattern during CPB correlated well with the angiography findings. TTFM during CPB was useful to detect graft failure, and grafts were revised safely during CPB.     

体外循环和非体外循环冠状动脉旁路术围手术期心肌损伤程度的对比研究

目的　对比研究常规体外循环下冠状动脉旁路术 (CCABG)和非体外循环心脏跳动下冠状动脉旁路术 (OPCAB)围手术期心肌肌钙蛋白I(cTnI)动态变化规律 ,以明确心肌损伤的程度。方法　 5 9例不稳定心绞痛患者 ,射血分数 (EF) 0 35～ 0 5 6 ,其中 34例行OPCAB ,患者平均年龄 (5 9 1± 1 7)岁 ,平均搭桥数 1 0～ 5 0支 ,平均 (2 90± 0 8)支 ;2 5例行CCABG ,患者平均年龄 (5 6 5± 1 8)岁。搭桥数 2 0～ 5 0支 ,平均 (3 2± 0 7)支。分别在术前 ,术后第 8、2 4、48、72、96、12 0h时 ,采集患者静脉血标本 ,离心后取血浆测定cTnI值。cTnI的测定采用自动双抗体夹心酶联免疫荧光测定法 ,仪器检测灵敏度cTnI 0 35 μg/L。　 结果　术前 2组患者cTnI差异无显著性意义 (P >0 0 5 )。OPCAB手术组cTnI值在术后观察期内均低于CCABG组 ,差异有显著性意义 (t=1 9432 ,P =0 0 0 7)。全组患者无死亡 ,均痊愈出院。　结论　cTnI是诊断心肌损伤的良好指标。OPCAB手术心肌损伤程度显著低于CCABG手术。     

Influence of vein graft use on postoperative 1-year results after off-pump coronary artery bypass surgery.

OBJECTIVE: We studied the postoperative 1-year results after off-pump coronary artery bypass surgery (OPCAB) with one or more saphenous vein grafts. METHODS: We compared the clinical and angiographic results of 833 patients who underwent OPCAB between 1998 and 2004. Group 1 patients (n=135) received one or more vein grafts. Group 2 patients (n=698) received total arterial grafts. Coronary angiographies were performed early postoperatively (n=804, 1.6+/-1.5 days), and 1 year postoperatively (n=671, 12.1+/-4.2 months). RESULTS: There were no significant differences in patient characteristics, operative mortalities, and morbidities between the two groups (p=ns). Both the early postoperative and 1-year angiographies demonstrated significantly lower overall graft patency rates in group 1 than in group 2 (early: 90.9% vs 99.1%, p<0.001; 1 year: 78.8% vs 95.1%, p<0.001), which might be affected by the lower vein graft patency rates in group 1 (early: 86.4%; 1 year: 67.9%). There was no difference in the 1-year patency of internal thoracic arteries between the two groups (94.3% vs 95.6%, p=0.402). Multivariate analysis demonstrated the use of vein graft (Odds ratio=5.204, p<0.001) as an independent predictor of graft failure during the first postoperative year. Target vessel revascularization rate during the postoperative 1 year was significantly higher in group 1 than in group 2 (7.4% vs 2.0%, p=0.002). CONCLUSIONS: Our study revealed that saphenous vein graft use in OPCAB independently predicted the graft failure while increasing the target vessel revascularization rate during the first postoperative year. Exclusive arterial revascularization would be a preferable strategy in OPCAB.     

Rationale of off-pump coronary artery bypass grafting for left main trunk disease

Objective: Off-pump coronary artery bypass grafting (OPCAB) remains controversial in patients with left main trunk (LMT) disease because of a concern about the ability to tolerate hemodynamic instability. This study examined the safety of OPCAB for LMT disease compared with conventional coronary artery bypass grafting (CABG). Methods: Between April 1997 and December 2002, 257 consecutive patients with LMT stenosis who underwent CABG were enrolled. There were 98 patients who received CABG with the aid of cardiopulmonary bypass (CCAB group), and 159 patients who received OPCAB (OPCAB group). Results: There was no patient who converted to on-pump intraoperatively due to hemodynamic instability. Both intraoperative blood loss and blood transfusion incidence were lower in the OPCAB group. Postoperative course was similar, however, pulmonary complications were less observed postoperatively in the OPCAB group. No hypoperfusion syndrome was seen postoperatively in both groups. The average number of anastomosis was 3.2±1.1 in the CCAB group and 3.2±1.0 in the OPCAB group (p=0.645). Total arterial OPCAB with an aorta no-touch technique was achieved in 142 patients (89.3%) in OPCAB group. Postoperative angiography was performed in 95 patients in CCAB (96.9%), and in 141 patients in OPCAB (89.8%). Although graft patency of arterial grafts was good in both groups (100% in CCAB and 98.3% in OPCAB), saphenous vein graft patency was slightly lower in both groups (93.4% in CCAB and 76.5% in OPCAB) compared with arterial grafts. Conclusion: OPCAB allows a safe and effective treatment of LMT disease.     

体外循环和非体外循环冠状动脉旁路移植术后心肌梗死发生率的Meta分析

目的 使用Meta分析比较常规体外循环冠状动脉旁路移植术(CCABG)和非体外循环冠状动脉旁路移植术(OPCAB)术后心肌梗死发生率的差异.方法 在 Medline、SCI、Cochrane图书馆临床对照试验注册库(CENTRAL)和中国生物医学文献光盘数据库(CBMdisc)检索中文和英文的相天随机对照临床试验,并检索相关文献的参考文献,检索时间截止至2009年1月.根据严格的纳入和排除标准,两名评价员独立地筛选文献,并按照Cochrane系统评价员手册5.0.0版所建议的评价方法 对纳入临床试验进行质量评价,最后将提取的资料用RevMan 5软件进行数据处理和分析.结果 共纳入22个试验进行Meta分析,OPCAB组共纳入1494例病人,心肌梗死总发生率为2.81%;CCABG组共1512例,心肌梗死总发生率为3.57%.Meta分析结果 显示OPCAB和CCABG术后心肌梗死发生率的差异尤统计学意义(OR=0.80,95%CI=0.54～1.20,P=0.28).结论 依据现有的随机对照试验进行Meta分析结果 显示,OPCAB和CCABG术后心肌梗死发生率的差异无统计学意义.     

体外循环和非体外循环冠状动脉旁路移植术后心肌梗死发生率的Meta分析

目的 使用Meta分析比较常规体外循环冠状动脉旁路移植术(CCABG)和非体外循环冠状动脉旁路移植术(OPCAB)术后心肌梗死发生率的差异.方法 在 Medline、SCI、Cochrane图书馆临床对照试验注册库(CENTRAL)和中国生物医学文献光盘数据库(CBMdisc)检索中文和英文的相天随机对照临床试验,并检索相关文献的参考文献,检索时间截止至2009年1月.根据严格的纳入和排除标准,两名评价员独立地筛选文献,并按照Cochrane系统评价员手册5.0.0版所建议的评价方法 对纳入临床试验进行质量评价,最后将提取的资料用RevMan 5软件进行数据处理和分析.结果 共纳入22个试验进行Meta分析,OPCAB组共纳入1494例病人,心肌梗死总发生率为2.81%;CCABG组共1512例,心肌梗死总发生率为3.57%.Meta分析结果 显示OPCAB和CCABG术后心肌梗死发生率的差异尤统计学意义(OR=0.80,95%CI=0.54～1.20,P=0.28).结论 依据现有的随机对照试验进行Meta分析结果 显示,OPCAB和CCABG术后心肌梗死发生率的差异无统计学意义.     

体外循环和非体外循环冠状动脉旁路移植术后心肌梗死发生率的Meta分析

目的 使用Meta分析比较常规体外循环冠状动脉旁路移植术(CCABG)和非体外循环冠状动脉旁路移植术(OPCAB)术后心肌梗死发生率的差异.方法 在 Medline、SCI、Cochrane图书馆临床对照试验注册库(CENTRAL)和中国生物医学文献光盘数据库(CBMdisc)检索中文和英文的相天随机对照临床试验,并检索相关文献的参考文献,检索时间截止至2009年1月.根据严格的纳入和排除标准,两名评价员独立地筛选文献,并按照Cochrane系统评价员手册5.0.0版所建议的评价方法 对纳入临床试验进行质量评价,最后将提取的资料用RevMan 5软件进行数据处理和分析.结果 共纳入22个试验进行Meta分析,OPCAB组共纳入1494例病人,心肌梗死总发生率为2.81%;CCABG组共1512例,心肌梗死总发生率为3.57%.Meta分析结果 显示OPCAB和CCABG术后心肌梗死发生率的差异尤统计学意义(OR=0.80,95%CI=0.54～1.20,P=0.28).结论 依据现有的随机对照试验进行Meta分析结果 显示,OPCAB和CCABG术后心肌梗死发生率的差异无统计学意义.