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。     

术中静脉注射胺碘酮对体外循环冠状动脉旁路移植术患者转归的影响

目的 评价术中静脉注射胺碘酮对体外循环冠状动脉旁路移植术患者转归的影响.方法 择期行体外循环冠状动脉旁路移植术的患者34例,ASA Ⅱ或Ⅲ级,年龄43～64岁,体重51～95kg,随机分为2组(n=17):对照组(C组)和胺碘酮组(A组).体外循环开始后,A组静脉注射胺碘酮5 mg/kg,C组注射等容量生理盐水.记录术毕至出院期间房颤的发生情况、术毕至首次发生房颤的时间、ICU停留时间和术毕至出院的时间.结果 两组ICU停留时间、术毕至出院时间、术毕至首次发生房颤的时间比较差异无统计学意义(P>0.05),A组房颤发生率低于C组(P<0.05).结论 术中静脉应用胺碘酮可在一定程度上预防体外循环冠状动脉旁路移植中患者术后房颤的发生,改善转归.     

OPCAB与CABG术后患者ICU监护的对比观察

目的探讨非体外循环心脏跳动下冠状动脉搭桥术（OPCAB）与体外循环下冠状动脉搭桥术（CCABG）术后ICU监护工作特点及临床意义。方法随机抽取甲组（n=32）OPCAB组;乙组（n=48）CABG组。通过对两组病人术后ICU内监护时间、辅助呼吸时间、住院总天数、术后引流量及术后并发症等方面作统计学处理和对比分析。结果两组患者术后ICU内监护时间、辅助呼吸时间、住院总天数、术后引流量均有显著性差异（P〈0．05）。结论非体外循环心脏跳动下冠状动脉搭桥术心功能稳定,并发症少,明显减少了药品使用和护理工作量,能为监护室的排班提供合理依据。     

Coronary surgery in patients with diabetes mellitus: a risk-adjusted study on early outcome

OBJECTIVES: We aimed at determining the effect of diabetes mellitus (diabetes) on short-term mortality and morbidity in a cohort of patients with ischemic disease undergoing coronary artery bypass surgery (CABG) at our institution. MATERIAL AND METHODS: A total of 4567 patients undergoing isolated CABG in a 10-year period were studied. Diabetes mellitus was present in 22.6% of the cases but the percentage increased from 19.1% in the beginning to 27% in the end of the study period (p<0.0001 for the decade time-trend). Compared with non-diabetic patients, the group with diabetes was older (61.5+/-8.4 years vs 60.4+/-9.5 years), had a higher body mass index (26.4+/-2.2 vs 26.0+/-2.2), comprised more women (17.5% vs 10.1%), and had a greater incidence of peripheral vascular disease (13.3% vs 8.8%), cerebrovascular disease (8.3% vs 4.3%), renal failure (2.7% vs 1.1%), cardiomegaly (14.0% vs 10.9%), class III-IV angina (43.4% vs 39.0%), triple-vessel disease (80.9% vs 73.7%) and patients with left ventricular dysfunction (all p<0.05). Demographic and peri-procedural data were registered prospectively in a computerized institutional database. Multivariate logistic regression was performed to assess the influence of diabetes as an independent risk factor for in-hospital mortality and morbidity. RESULTS: The overall in-hospital mortality was 0.96% [n=44; diabetics: 1.0%, non-diabetics: 0.9% (p=0.74)]. The mortality of patients with diabetes decreased from 2.7% in the early period to 0.7% in the late period (p=0.03 for the time-trend). Postoperative in-hospital complications were comparable in the two groups in univariate analysis, with only cerebrovascular accident and prolonged length of stay being significantly higher in the diabetic patients (all p<0.05). In multivariate analysis, diabetes was not found to be an independent risk factor for in-hospital mortality (OR=0.61; 95% CI=0.28-1.30; p=0.19), but predicted the occurrence of mediastinitis (OR=1.80; 95% CI=1.01-3.22; p=0.049). CONCLUSIONS: Despite worse demographic and clinical characteristics, diabetic patients could be surgically revascularized with low mortality and morbidity, comparable with control patients. Hence, our data do not support diabetes as a risk factor for significantly adverse early outcome following CABG.     

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.     

Myocardial revascularization in patients with end-stage renal disease: Comparison of percutaneous transluminal coronary angioplasty and coronary artery bypass grafting

Background: Ischemic heart disease is the major cause of death inpatients with end-stage renal disease. The high prevalence of coronary artery disease results in a rising number of dialysis patients requiring myocardial revascularisation. Objective: The objective of this study was to compare the outcomes of recurrent angina, myocardial infarction, rate of reinterventions and cardiovascular death following percutaneous coronary angioplasty (PTCA) or coronary artery bypass grafting (CABG) inpatients with end-stage renal disease. Patients and methods: In a retrospective investigation 40 patients with chronic renal failure undergoing primarily PTCA and 65 patients undergoing CABG were included. Both groups were comparable for gender, duration on dialysis and the number of cardiovascular risk factors per patient. Patients undergoing PTCA were younger (53 ± 12 years vs. 57 ± 8 years; p < 0.05) and more often diabetics (30% vs. 14%; p < 0.05). Results: Most patients in both groups had a multi-vessel disease (95% in the CABG group vs. 74% in the PTCA group), in the CABG group there were significantly more patients with a triple-vessel disease (62% with vs. 40%in the PTCA group; p < 0.01), PTCA was primarily successful in 95% of the patients while complete revascularization was achieved in 88% of patients undergoing CABG. The perioperative mortality after CABG was 4.8% as compared to none after interventional revascularisation. The cumulative freedom of angina after 6, 12 and 24 months after intervention was significantly lower after PTCA (54%, 40%, 29%) than after bypass grafting (97%, 94%, 90%, p < 0.001). The frequency of reinterventions following PTCA was significantly higher compared to patients following CABG (p < 0.001). After PTCA 15 patients needed further revascularisations, 8 of them underwent CABG, whereas after CABG only two patients required additional myocardial revascularisation. There was no significant difference in the overall mortality between both groups; the survival rate after 12 and 24 months was 95% and 82% after PTCA and 93% and 86% after CABG, respectively. Condition: Although patients receiving CABG had a more severe coronary artery disease the overall mortality was comparable and clinical and functional outcome was improved compared to patients after coronary angioplasty. This revised version was published online in June 2006 with corrections to the Cover Date.     

术前置入主动脉内球囊反搏对高危冠状动脉旁路移植术患者预后的影响

目的比较高危冠心病患者术前预防性置入主动脉内球囊反搏(IABP)和被动紧急置入IABP对临床预后的影响. 方法 35例接受冠状动脉旁路移植手术同时需接受IABP置入的患者,根据置入的时机不同分为两组.术前置入组 接受术前预防性置入IABP;对照组术中或术后接受紧急置入IABP.比较两组围术期死亡率、心肌梗死发生率、术后心功能不全和需要正性肌力药物辅助的程度、IABP使用的时间、术后呼吸机辅助时间和重症监护治疗病房(ICU)停留时间. 结果术前置入组围手术期死亡率和心肌梗死发生率分别为11.1%和0%,较对照组低(65.4%,50%;P＝0.007,0.013);两组呼吸机辅助通气时间、IABP使用时间、术后需正性肌力药物辅助时间以及术后平均住ICU时间差别均有显著性意义(P＜0.05). 结论术前预防性置入IABP能降低围术期死亡率、心肌梗死发生率,减少对正性肌力药物的需要量和缩短住ICU时间.     

Effects of mild hypothermic cardiopulmonary bypass on blood viscoelasticity in coronary artery bypass grafting patients

The purpose of this study was to determine the changes in blood viscoelasticity during and after coronary artery bypass grafting (CABG) and to identify correlations between blood viscoelasticity and patients' age, duration of cardiopulmonary bypass (CPB), and cross-clamp time. After Institutional Review Board approvals, patients (n = 10) who were subjected to mild hypothermic CPB were included in this study. Viscosity and elasticity were measured at strains of 0.2, 1, and 5 using a Vilastic-3 Viscoelasticity Analyzer. Arterial blood samples were collected pre-CPB, on normothermic CPB, hypothermic CPB, after rewarming, and after CPB. Viscosity and elasticity at strains of 0.2 and 1 were altered significantly during and after CPB compared to the pre-CPB (p < 0.01). In particular, elasticity of blood was diminished during normothermic bypass and could not be recovered after CPB (p < 0.01). Although there were strong correlations between blood viscoelasticity, duration of CPB, and cross-clamp time on normothermic CPB, only the patients' age showed a positive correlation between viscosity (r = 0.61, p = 0.05), and elasticity (r = 0.89, p < 0.001) after CPB. These results suggest that mild hypothermic CPB alters the blood viscoelasticity during and after CABG.     

微创体外循环对冠状动脉旁路移植术的临床效果观察

目的 观察微创体外循环(MECC)对冠状动脉旁路移植术临床效果的影响.方法 将60例在我院行进行冠状动脉旁路移植术的患者分为MECC组、传统的心肺旁路(CCPB)组各30例.记录患者术中、术后各项临床指标并进行分析.结果 两组患者年龄、性别、体表面积、术前血红蛋白、术前血球压积以及左室射血分数比较,差异无统计学意义.术中两组病例阻断时间和总转流时间均无差异,但转中最低血红蛋白和体外用血量存在明显差异(P ＜0.001).ICU红细胞用量MECC组少于CCPB组(P＜0.05);ICU机械通气时间MECC组明显少于CCPB组；ICU住院时间两组无差异.ICU第一个24小时胸引量MECC组少于CCPB组(P＜0.05).结论 MECC与CCPB相比,在冠状动脉旁路移植术中是安全可靠的,能大幅减少血液制品的使用.     

Early and late outcome after coronary artery bypass surgery in diabetic patients

Objective. To determine the impact of diabetes on outcome after coronary artery bypass surgery. Design. We matched 866 diabetic patients with non-diabetic controls in regards to gender, age, left ventricular ejection fraction, body mass index, presence of unstable angina and history of myocardial infarction, and day of surgery. The 30-d mortality and morbidity were evaluated with univariate analysis and survival and freedom from cardiac death were assessed with the Kaplan–Meier method. Results. Follow-up time was 69±37 months. The 30-d mortality was 2.0% in the diabetic group and 1.0% in the non-diabetic group (p=0.15). Postoperative morbidity did not differ between groups. Cumulative 5- and 10-year survival rates were 89 and 71% in diabetics and 94 and 84% in non-diabetics (p=0.001). During follow-up, there was no difference between groups in regards to repeat revascularization. Conclusions. The 30-d mortality was equally low in diabetic and non-diabetic patients with severe coronary artery disease. However, long-term survival was significantly lower in the diabetic group than in the non-diabetic group.     

Risk-adjusted analysis of long-term outcomes after on- versus off-pump coronary artery bypass grafting

 Open in a separate windowOBJECTIVESRecent data suggested that off-pump coronary artery bypass (OPCAB) may carry a higher risk for mortality in the long term when compared to on-pump coronary artery bypass (ONCAB). We, therefore, compared long-term survival and morbidity in patients undergoing ONCAB versus OPCAB in a large single-centre cohort.METHODSA total of 8981 patients undergoing isolated elective/urgent coronary artery bypass grafting between January 2009 and December 2019 were analysed. Patients were stratified into 2 groups (OPCAB n = 6649/ONCAB n = 2332). The primary end point was all-cause mortality. Secondary endpoints included repeat revascularization, stroke and myocardial infarction. To adjust for potential selection bias, 1:1 nearest neighbour propensity score (PS) matching was performed resulting in 1857 matched pairs. Moreover, sensitivity analysis was applied in the entire study cohort using multivariable- and PS-adjusted Cox regression analysis.RESULTSIn the PS-matched cohort, 10-year mortality was similar between study groups [OPCAB 36.4% vs ONCAB 35.8%: hazard ratio (HR) 0.99, 95% confidence interval (CI) 0.87–1.12; P = 0.84]. While 10-year outcomes of secondary endpoints did not differ significantly, risk of stroke (OPCAB 1.50% vs ONCAB 2.8%: HR 0.51, 95% CI 0.32–0.83; P = 0.006) and mortality (OPCAB 3.1% vs ONCAB 4.8%: HR 0.65, 95% CI 0.47–0.91; P = 0.011) at 1 year was lower in the OPCAB group. In the multivariable- and the PS-adjusted model, mortality at 10 years was not significantly different (OPCAB 34.1% vs ONCAB 35.7%: HR 0.97, 95% CI 0.87–1.08; P = 0.59 and HR 1.01, 95% CI 0.90–1.13; P = 0.91, respectively).CONCLUSIONSData do not provide evidence that elective/urgent OPCAB is associated with significantly higher risks of mortality, repeat revascularization, or myocardial infarction during late follow-up when compared to ONCAB. Patients undergoing OPCAB may benefit from reduced risks of stroke and mortality within the first year postoperatively.     

Association of incomplete revascularization with long-term survival after off-pump coronary artery bypass grafting

Background

We evaluated the effect of incomplete revascularization (IR) on the long-term outcomes after off-pump coronary artery bypass grafting.

Materials and methods

Of 1553 patients with triple-vessel disease who had undergone consecutive off-pump coronary artery bypass grafting, 1351 (87.0%) had complete revascularization (CR) and 202 had IR (13.0%). After propensity score patient matching, we had 200 patients in each group. Cardiac survival and major adverse cardiac and cerebrovascular events (MACCE) were assessed before and after patient matching. Subgroup analysis was performed to evaluate the interaction between the left ventricular ejection fraction (LVEF) and the completeness of revascularization. The follow-up duration was 60 mo.

Results

In the all-patient analysis, the CR group had a lower incidence of in-hospital mortality, cardiac mortality, and MACCE (P = 0.033, P < 0.001, and P = 0.003, respectively). The 5-year cardiac survival was 96.5% ± 0.6% in the CR group and 88.9% ± 2.5% in the IR group (P < 0.001), with a freedom from MACCE rate of 85.4% ± 1.2% and 78.8% ± 3.4%, respectively (P = 0.015). After patient matching, the CR group showed superior 5-year cardiac survival compared with the IR group (96.2% ± 1.4% versus 88.8% ± 2.5%, P = 0.022), with a similar freedom from MACCE rate. IR was identified as an independent predictor of cardiac death (hazard ratio 2.76, 95% confidence interval 1.62–4.70; P < 0.001). IR predicted cardiac death more distinctly in patients with a low LVEF (hazard ratio 5.29, 95% confidence interval 1.71–16.39; P = 0.004) than in those with a preserved LVEF (hazard ratio 2.04, 95% confidence interval 1.02–4.08; P = 0.045).

Conclusions

CR in off-pump coronary artery bypass grafting was related to superior cardiac survival after 5 years of follow-up compared with IR. The benefit of CR was more distinct in those with a low LVEF. CR should be achieved whenever possible, especially in patients with a low LVEF.     

Breast necrosis following coronary artery bypass grafting

We present a case of left breast necrosis following coronary artery bypass grafting which was misdiagnosed as a breast cancer. Breast necrosis after myocardial revascularization is an extremely rare complication of the surgical procedure using the most conventional graft which is the left internal mammary artery. The left internal mammary artery is the main blood supplying artery of the left breast.     

七氟醚对心肺转流冠状动脉旁路移植术的心肺保护作用

目的 比较七氟醚与丙泊酚对心肺转流(CPB)冠状动脉旁路移植术(CAEG)患者心肌与肺功能的保护作用.方法 择期CPB下行CABG患者52例,ASAⅡ或Ⅲ级,心功能Ⅱ或Ⅲ级,随机均分为七氟醚组(S组)与丙泊酚组(P组).夹闭主动脉后,S组通过膜肺吹入0.5%～3%七氟醚,P组靶控输注丙泊酚2～3μg/kg.予术前、术后2、4、8 h行血气分析,计算肺泡-动脉氧分压差[D(A-a)O<,2>]、呼吸指数(RI)及氧合指数(OI);予术前、术后6、12、24、48 h检测肌酸激酶同工酶(CK-MB)与肌钙蛋白I(cTnI)水平;记录房颤(Af)发生率、心肌缺血率、射血分数(EF)、自动复跳率及呼吸支持时间.结果 术后各时点S组患者D(A-a)O<,2>与RI明显低于P组(P<0.05);而OI明显高于P组(P<0.05).S组术后CK-MB与cTnl明显低于P组(P<0.01).Af发生率与心肌缺血率明显低于P组,呼吸支持时间明显短于P组(P<0.05),EF值和自动复跳率明显高于P组(P<0.05).结论 CPB下CABG中通过膜肺给予七氟醚对患者心肌与肺功能有一定的保护作用.     

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.     

Hemoglobin Trends in Isolated Coronary Artery Bypass Grafting Performed Off‐Pump and With Standard and Mini Circuits

The comparison of hemodilution at the end of surgery is of limited use as it represents only a snapshot of a dynamic phenomenon. This study was undertaken to compare the perioperative hemoglobin curves of isolated coronary artery bypass grafting performed with minimized extracorporeal circulation, traditional cardiopulmonary bypass, and off‐pump technique. The propensity score method was used to select three groups of patients, homogenous regarding preoperative and operative data, who underwent isolated coronary artery bypass grafting. A generalized linear mixed model was used for estimating differences in perioperative hemoglobin trends among groups. The three groups were each composed of 50 patients with no differences in demographic data, preoperative risk profile, preoperative hemoglobin, or type of surgery. There was no significant difference in major postoperative complications. The pattern of the hemodilution curves was similar in patients operated with mini‐circuit and off‐pump technique (P > 005). Mini‐circuit led to a 3.1 ± 11.9% hemoglobin reduction, which was similar to the off‐pump group (1.6 ± 8.9%, P = 0.99 at ANOVA) and significantly different from the standard extracorporeal circuit group (16.0 ± 10.3%, P < 0.001 at ANOVA). The generalized linear mixed model determined that the standard circuit was the only independent predictor for increased hemodilution. Its effect on hemodilution was time‐dependent and the slope of the hemoglobin curve was more pronounced between systemic heparinization and the end of surgery. Perioperative hemoglobin trends of patients who underwent myocardial revascularization with mini‐circuit were similar to those of off‐pump surgery and significantly less pronounced than those of standard extracorporeal circulation.     

Coronary artery bypass grafting for dialysis patients: usefulness of multiarterial bypass

This study assessed the efficacy of multiarterial bypass in coronary artery bypass grafting (CABG) in dialysis patients. Eighty dialysis patients who underwent CABG were divided into 2 groups. Group A consisted of 38 patients in whom the left internal thoracic artery and additional saphenous vein graft (SVG) had been used. Group B consisted of 42 patients in whom 2 or 3 arterial grafts and additional SVGs had been used. No mediastinitis was shown in either group. Actuarial survival rates, including all deaths, and estimated by cardiac deaths at 8 years, were 28% and 83%, respectively, in Group A and 93% and 100%, respectively, in Group B with a significant difference (p = 0.014 and 0.016, respectively). Cardiac event-free rates at 8 years were 43% and 96% in Groups A and B, respectively, with a significant difference (p = 0.0016). Multiarterial grafting improved long-term results after CABG for dialysis patients compared with single internal thoracic artery grafting with minimal complications related to graft harvesting.     

非体外循环冠状动脉旁路移植术后低氧血症相关因素分析

目的分析非体外循环冠状动脉旁路移植术(Offpump coron aryartery bypass grafting,OPCABG)后低氧血症的影响因素。方法回顾性分析135例患者OPCABG术后并发低氧血症44例,对患者的年龄、性别、吸烟史、体质量、高血压、糖尿病、冠脉病变、术前心功能与低氧血症进行相关性分析。结果 CABG患者高龄、肥胖、长期大量吸烟及术前心功能底下与低氧血症有显著相关;性别、糖尿病、高血压、冠脉病变支数与CABG术后低氧血症发生率无明显相关性。结论 OPCAB术后低氧血症与多种因素有关,预防措施包括术前、术中、术后的各个阶段。     

不停跳和心肺转流下冠状动脉搭桥术后呼吸动力学的变化

目的研究不停跳和心肺转流（CPB）下冠状动脉搭桥术对呼吸动力学的影响,并观察这些变化与时间的关系。方法择期行冠状动脉搭桥术的冠心病患者26例,根据是否应用CPB分成两组：CPB组（n=13）和不停跳冠状动脉搭桥组（OPC组,n=13）。在围术期用BICORECP-100呼吸功能监测仪监测胸肺顺应性、气道阻力、呼吸功等呼吸动力学指标的变化。结果两组的胸肺顺应性术后均出现降低,CPB组于术后3、6h较诱导后明显降低（P〈0．05或P〈0．01）,术后10h基本恢复至诱导后水平;而OPC组术后3h较诱导后明显下降（P〈0．05）,术后10h基本恢复。两组的气道阻力术后均出现增加,CPB组于术后6h高于诱导后水平（P〈0．05）,然后逐渐下降;OPC组于术后3h高于诱导后水平（P〈0．05）,术后10h基本恢复。两组的呼吸功均于术后3h明显增加（P〈0．05）,至术后10h后基本恢复。两组间呼吸动力学的比较差异均无统计学意义。两组患者术后呼吸支持时间相同。结论不停跳冠脉搭桥与CPB下冠脉搭桥术对术后呼吸动力学的改变相似,因此术后早期拔管也应谨慎。     

Minimally invasive coronary artery bypass grafting via a small thoracotomy versus off-pump: a case-matched study

Objective: The minimally invasive coronary artery bypass grafting (MICS CABG) operation performed via a small thoracotomy has not previously been examined in a direct comparison to sternotomy off-pump coronary artery bypass grafting (OPCAB). Methods: We matched, according to age, gender, left ventricular function, and median number of distal anastomoses, 150 patients who underwent MICS CABG via small left thoracotomy, and 150 patients who received sternotomy OPCAB. All operations were performed by the same surgeon. Results: There was no perioperative mortality (0/300). In the MICS CABG group, pump assistance was used in 28/150 (19%) patients, and conversion to sternotomy occurred in 10/150 (6.7%) patients. In the OPCAB group, conversion to on-pump occurred in 3/150 (2.0%) patients. There were four (2.7%) reoperations for bleeding and one (0.7%) for anastomotic revision in each group. The median hospital length of stay was 5 days for MICS CABG (average 5.4), and 6 days for OPCAB (average 7.2) (P = 0.02). New-onset atrial fibrillation occurred in 35 (23%) MICS CABG patients and in 42 (28%) OPCAB patients (P = 0.3). No wound infection occurred with MICS CABG versus six (4.0%) with OPCAB (P = 0.03). A self-limiting left pleural effusion developed in 22 (15%) MICS CABG patients and in six (4.0%) OPCAB patients (P = 0.002). The median time to return to full physical activity was 12 days in MICS CABG patients versus >5 weeks in OPCAB patients (P < 0.001). Conclusions: MICS CABG is a valuable alternative for patients in need of multivessel CABG. The operation appears at least as safe as OPCAB, and associated with shorter hospital length of stay, less wound infections, and faster postoperative recovery than OPCAB.