心脏不停跳冠状动脉旁路移植术的中期随访分析

目的探讨心脏不停跳冠状动脉旁路移植术(OPCAB)的围手术期特点及中期随访结果分析。方法回顾性总结从1998年11月至2008年12月期间,我科实施的单纯冠状动脉旁路移植术患者的围术期资料,包括心脏停跳下冠状动脉旁路移植术(CCAB)92例和OPCAB 151例,比较分析了术前常见的危险因素和围手术期临床资料,并对术后7年中期随访情况进行比较分析。结果术前危险因素中,除年龄和糖尿病外其余在两组之间无明显差别。OPCAB组与CCAB组比较,平均远端血管吻合口数明显减少(3.08±0.76比3.34±0.76,P=0.025),手术时间、术后机械通气时间、术后ICU时间和术后住院天数则显著缩短,术后主要并发症(如低心排出量、IABP使用、肾功能不全)明显减少,住院死亡率无明显差别。术后中期随访结果显示OPCAB组射血分数显著比CCAB组高(63.1%±11.7%比59.0%±10.8%,P=0.049),OPCAB组血管桥闭塞率也明显高于CCAB组(44.7%比18.8%,P=0.022)。结论 OPCAB在术后恢复和术后主要并发症减少方面均明显优于CCAB。从术后中期的随访来看,OPCAB组射血分数显著高于CCAB组,显示OPCAB在心功能恢复方面优于CCAB。术后7年OPCAB组血管桥闭塞率显著高于CCAB组,说明OPCAB操作难度大,可能影响了血管桥的中期通畅率。

Clinical Outcome of Coronary Artery Bypass Grafting and Analysis of Midterm Follow-up

Aim To explore and analyze the advantage of off-pump coronary artery bypass (OPCAB) compared with conventional coronary artery bypass (CCAB). Methods 92 cases of CCAB and 151 cases of OPCAB were collected from Nov.1998 to Dec.2008, and the clinical data were summarized and analyzed retrospectively. Results The preoperation risk factors had no significant difference between CCAB group and OPCAB group except for diabetes. There were more mean graft numbers in CCAB group than in OPCAB group. But operation time, intubation time, ICU stay time, postoperative stay time, low cardiac output, IABP use time and renal dysfunction in OPCAB group were obviously less than in CCAB group, with no significant difference in hospital death between the two groups. Seven years postoperative follow-up result indicated that heart function improved obviously and ejection fraction (EF) value was higher in OPCAB group than in CCAB group. Conclusions There was apparent advantage in postoperation recovery and reduction of postoperation complications in OPCAB compared with CCAB, and OPCAB is a hopeful surgical method for coronary artery disease. The heart function recovers more quickly in OPCAB group than in CCAB group. The rate of graft occlusion in OPCAB group was higher than in CCAB group.