体外循环与非体外循环冠状动脉旁路移植术围术期治疗结果对比分析

目的：比较体外循环冠状动脉旁路移植术(conven-tional coronary artery bypass grafting,CCABG)与非体外循环冠状动脉旁路移植术(off-pump coronary artery bypass grafting,OPCABG)治疗结果，评价两种方法优越性．方法：将350例冠状动脉旁路移植术患分为0PCABG和CCABG组，0PCABG组在非体外循环心脏跳动下完成冠状动脉旁路移植术，CCABG组建立常规体外循环，心脏停跳或跳动下完成冠状动脉旁路移植术．对两组患的术前及术后各指标进行对比分析．结果：两组患术前治疗及一般情况如性别、年龄、体质量、心梗史、心功能、合并糖尿病、高血压等无差别；手术时间、血管桥数无差别；术后0PCABG组呼吸机辅助时间、住ICU时间、住院时间及住院费用比CCABG组低，术后早期并发症如开胸止血、伤口感染、心律失常、呼吸道并发症等的发生率0PCABG组为6．4％，CCABG组为9．1％，0PCABG组无1例死亡，CCABG组死亡率为1．5％，两组比较无显性差异．结论：0PCABG可减少手术创伤，缩短术后呼吸机辅助时间、ICU治疗时间及住院时间，降低住院费用，但不能替代CCABG．

Comparative analysis of therapeutic results between CCABG and OPCABG during perioperative period

AIM: To compare the therapeutic results between CCABG and OPCABG and evaluate their advantages. METHODS: 350 patients of coronary artery bypass transplantation were divided into OPCABG group and CCABG group. In OPCABG group, coronary artery bypass grafting was conducted under off pump with heart beating, while in CCABG group, conventional extracorporeal circulation was established and coronary artery bypass grafting was performed with heart beating or without heart beating. Compare and analyze indexes of the two groups before and after operation. RESULTS: There was no difference in the preoperative treatment, no difference between general conditions such as sex, age, weight, cardiac infarction history, cardiac function, combined diabetes, hypertension and no difference in operation time and the number of bridgings between CCABG and OPCABG. The time of using respirator, residence time in ICU and residence time in hospital were shortened in OPCABG group and expense of OPCABG group after operation were lower than those of CCABG group. In OPCABG group, the incidence of early postoperative complications, such as thoracotomy hemostasis, wound infection, arrhythmia and respiration tube complication, was 6.4%, while 9.1% in CCABG group. No death in OPCABG group, while the death rate in CCABG group was 1.5% and there was no significant difference between two groups. CONCLUSION: OPCABG can reduce operative trauma, shorten the postoperative time of using respirator, residence time of ICU and residence time in hospital and lower the expense in hospital. But it cannot replace CCABG.