1650例男性患者冠状动脉旁路移植术围术期临床回顾性研究

目的 冠状动脉旁路移植术（coronary artery bypass grafting,CABG）是治疗冠状动脉粥样硬化性心脏病（以下简称冠心病）主要手段之一,主要手术方式包括体外循环下冠状动脉旁路移植术（on-pump CABG,ONCABG）和非体外循环下冠状动脉旁路移植术（off-pump CABG,OPCABG）.本文拟通过回顾性分析1 650例男性患者施行OPCABG和不停跳ONCABG临床资料进行两种手术方式的临床效果分析.方法 采用首都医科大学附属北京安贞医院麻醉科2007年至2009年CABG数据库的有关数据.比较OPCABG组和不停跳ONCABG组近期疗效,并分别以术后死亡和术后应用连续性肾脏替代治疗（continuous renal replacement treatment,CRRT）为因变量进行Logistic危险因素回归分析.结果 OPCABG组搭桥时间和总手术时间均小于ONCABG组（P〈0.01）.OPCABG组搭桥数大于3的病例明显多于ONCABG组（20.9% vs 13.3%） （P〈0.01）,应用CRRT（1.33% vs 3.98%）和主动脉内球囊反搏（3.23% vs 6.63%）患者的比例较ONCABG组显著减少（P≤0.01）,两组术后院内病死率差异无统计学意义.CABG术后发生院内死亡的独立危险因素为术前左室射血分数（left ventricular ejection fraction,LVEF）〈40%（P=0.000,OR=8.321）、年龄〉70岁（P=0.003,OR=4.870）和术后应用CRRT（P=0.000,OR=45.500）.术后应用CRRT的独立危险因素为术前高血压病史（P=0.049,OR=2.665）、术前肾功能异常（P=0.045,OR=3.598）,OPCABG可以减少2/3的术后CRRT的使用率（P=0.008,OR=0.333）.结论 OPCABG可以降低术后CRRT和IABP的使用率,缩短手术时间.因此在年龄〉70岁,术前肾脏功能下降,心功能差等患者施行OPCABG手术对早期恢复是有益的.

Analysis of coronary artery bypass grafting in 1650 male patients undergoing coronary artery bypass grafting

Objective Coronary artery bypass grafting （CABG） is generally considered the principal therapy for patients with coronary heart disease, which consisted of on-pump CABG （ONCABG） or off-pump CABG （OPCABG）. To compare the earlier clinical results between heart-beating on-pump and off-pump CABG in 1 650 male patients. Methods The perioperative data of 1 650 male patients who underwent CABG were investigated based on the perioperative CABG database from 2007 to 2009. The earlier clinical results between heart-beating on-pump and off-pump CABG were compared. The risk factors of postoperative in-hospital mortality and CRRT were also identified by multiple logistic regressions. Results The duration of CABG and total operation of OPCABG group were less than those of ONCABG group（P 〈 0. 01 ）. There were more cases of grafts 〉 3 （20. 9% vs 13.3% ） （P 〈 0. 01 ） and less cases of CRRT（ 1.33% vs 3.98% ）and IABP（3.23% vs 6.63% ）in OPCABG group. There was no significant difference in in-hospital mortality between two groups. Multivariate analysis demonstrated that preoperative ejection fraction （EF） less than 40% （ P = 0. 000, OR = 8.321 ） , more than 70 years （ P = 0.003, OR = 4. 870 ） and postoperative CRRT （ P = 0. 000, OR = 45. 500 ） were the independent risk factors of postoperative in-hospital mortality; preoperative hypertension （ P = 0. 049, OR = 2. 665 ）, preoperative renal dysfunction （ P = 0. 045, OR = 3. 598 ） were the independent risk factors, while the usage rate of continuous renal replacement therapy （CRRT） was reduced by two thirds in male patients undergoing off-pump coronary artery bypass grafting. Conclusion OPCABG was a better alternative to heart-beating ONCABG for patients with age 〉 70 years and/or preoperative poor renal function and/or cardiac dysfunction.