体外与非体外循环对冠状动脉旁路移植术后谵妄的影响

比较体外与非体外循环冠状动脉旁路移植术对患者术后谵妄发生率的影响。方法：回顾性分析阜外医院SICU自2020年1月至2021年4月收治的单纯行冠脉搭桥患者信息,根据手术方式分为体外循环组和非体外循环组。比较两组患者的基本信息、基础疾病,术前超声EF值和术前血肌酐水平。终点指标为两组患者住院期间的谵妄发生率。结果：共607例患者纳入本研究,其中体外循环组495例,非体外循环组112例。两组患者年龄、性别比例、基础疾病（高血压、糖尿病、既往卒中史）、术前最后一次EF值、术前血肌酐值均无统计学差异。术中平均搭桥个数两组无统计学差异,体外循环组平均转机时间123.7±46.8分钟,阻断89.9±33.6分钟。术后呼吸机使用时间两组无统计学差异。ICU停留时间体外循环组高于非体外组（3.0±1.8 vs 2.5±1.7天,t：2.603,p：0,009）。术后MACCE事件及CRRT两组均无统计学差异。体外循环组105例患者发生谵妄（21.2%）,非体外循环组14例发生术后谵妄（12.5%）。基于倾向性评分的逆概率加权回归分析提示OR值为2.402（95%CI, 1.337-4.317）,P=0.004。结论：非体外循环冠状动脉旁路移植术可降低术后患者谵妄的发生率。     

非体外循环冠状动脉旁路移植术围术期护理

<正>非体外循环冠状动脉旁路移植术(OPCAB)是不采用体外循环在跳动的心脏上进行冠状动脉搭桥的手术,是一种具有微创性的心脏外科手术,减少乃至避免了常规体外循环下冠状动脉旁路移植术所引起的心肌缺血再灌注损伤和体外循环损伤,较常规体外     

非体外循环不停跳与体外循环冠状动脉旁路移植手术在老年患者中的应用比较

目的探讨非体外循环不停跳与体外循环冠状动脉旁路移植手术在老年患者中的应用效果。方法该院2011年7月至2013年6月收治的老年冠心病(CHD)患者97例,回顾性分析其临床资料,根据手术方式分组。将接受非体外循环不停跳冠状动脉旁路移植手术治疗的45例患者纳入非体外循环组,接受体外循环冠状动脉旁路移植手术治疗的52例患者纳入体外循环组。对比两组在手术时间、呼吸机辅助时间、ICU时间、住院时间、术后并发症发生率、死亡率等方面的差异性。结果与非体外循环组对比,体外循环组患者手术时间、呼吸机辅助时间、ICU时间、住院时间较长,术后并发症发生率较高(P<0.05)。两组死亡率差异无统计学意义(P>0.05)。结论对老年CHD患者采用非体外循环不停跳冠状动脉旁路移植手术治疗,康复时间短、并发症风险小,今后可将其作为老年CHD患者的首选治疗方案进行推广应用。     

70岁及以上老年患者非体外循环冠状动脉旁路移植术

目的　探讨非体外循环冠状动脉旁路移植术 (OPCAB)在 70岁及以上 (≥ 70岁 )老年冠心病患者施行的可行性和优越性。　方法　回顾性分析≥ 70岁患者 6 3例及 70岁以下 (<70岁 )患者197例施行OPCAB的临床资料。≥ 70岁组术前有脑血管病史和慢性阻塞性肺病史的比例大于 <70岁组 (P <0 0 5 ) ,其余相关因素差异无显著性。　结果　≥ 70岁组和 <70岁组平均远端吻合口数目分别为 (3 5± 0 9)个和 (3 4± 0 8)个 ,差异无显著性 (P >0 0 5 )。≥ 70岁组采用动脉桥的比例明显少于 70以下组 (分别占 12 7%及 5 2 3% ,P <0 0 1) ,监护时间大于 72h和机械通气大于 12h的比例 ,≥70岁组明显增多 (P <0 0 5 )。≥ 70岁组输血比例明显大于 <70岁组 (P <0 0 5 )。 2组死亡率分别为1 6 %和 1 0 % ,差异无显著性。心律失常的发生 ,≥ 70岁组明显多于 <70岁组 (P <0 0 5 ) ,其余并发症差异无显著性。　结论　OPCAB手术对于≥ 70岁老年冠心病患者同样安全可行 ,临床效果好     

老年患者冠状动脉旁路移植术及其围术期处理

随着冠状动脉旁路移植术(coronary artery bypass graft,CABG)在国内的迅速发展,老年患者的CABG将越来越多.本文报道1993年3月至2004年2月39例老年患者施行CABG及其围术期处理体会.     

非体外循环和体外循环高龄冠状动脉旁路移植术临床分析比较

目的:比较75岁以上老年患者行非体外循环冠状动脉旁路移植术(Off-pump CABG)与体外循环冠状动脉旁路移植术(On-pump CABG)的临床效果。方法:59例75岁以上老年患者,Off-pump CABG组(10例);On-pump CABG组(49例)。结果:Off-pump组手术时间、引流量600mL、呼吸机辅助时间20h、正性肌力药物使用时间36h指标均少于或低于On-pump组(P0.05,或P0.01)。On-pump组死亡2例,死于多脏器功能衰竭和恶性心律失常。Off-pump组无死亡。结论:对75岁以上的老年冠心病患者行冠状动脉旁路移植术是安全可行的。2组比较,Off-pump组手术有时间短、引流量少、呼吸机辅助时间短及正性肌力药物使用时间短等优点。     

体外与非体外循环冠脉旁路移植术的观察与护理

目的：比较体外循环冠脉旁路移植术与非体外循环心脏不停跳下冠脉旁路移植术后疗效及护理的差异。方法：同期215例冠脉旁路移植术患，其中体外循环冠脉旁路移植术109例，非体外循环心脏不停跳冠脉旁路移植术106例，分别观察术后并发症、死亡率以及ICU监护期辅助呼吸时间、ICU监护时间、术后住院天数。结果：经统计学处理．非体外循环冠脉旁路移植术组术后并发症、低心排综合征、肾功能衰竭、应用IABP例数、死亡率、辅助呼吸时间、ICU监护时间、术后住院天数均低于体外循环冠脉旁路移植术组，除胸部并发症P＜0．05外余P均＜0．01。结论：非体外循环下冠脉旁路移植术优于体外循环冠脉旁路移植术。     

非体外循环冠状动脉旁路移植术的麻醉和围术期管理

目的 探讨非体外循环冠状动脉旁路移植术(OPCAB)的麻醉和围术期管理。方法 择期OPCAB患者18例,ASA分级Ⅲ～Ⅳ级,采用咪达唑仑、依托咪酯、普鲁泊福、芬太尼、维库溴铵、异氟烷等行常温静吸复合全麻。术中应用硝酸甘油、艾司洛尔、去氧肾上腺素、尼卡地平、山莨菪碱。结果18例手术均在非体外循环下完成,围术期循环稳定,无麻醉并发症,所有患者均痊愈出院。结论 OPCAB的麻醉和围术期管理的关键在于维持心肌氧供需的平衡,避免加重心肌缺血,同时要维持血液动力学平稳。     

冠状动脉旁路移植术中体外循环对肾功能的影响

目的:了解冠状动脉旁路移植术中体外循环对病人肾功能损伤的影响。方法:689例行冠状动脉搭桥术患者按施行体外循环与否及体外循环时间进行分组。分析术前及术后的肾功能指标水平。结果:冠状动脉旁路移植术后肾功能指标:血肌酐(Cr)、尿素氮(BUN),尿α-微量蛋白(MG)各指标水平较术前均有明显升高(P<0.01).体外循环组较非体外循环组升高更明显(P<0.05～<0.01);体外循环时间超过150 min者的升高最明显(P<0.01)。结论:非体外循环CABG术对病人肾功能损害影响的小于有体外循环的CABG术,过长时间的体外循环时间对肾功能损害的影响更大。     

糖尿病患者非体外循环冠状动脉旁路移植术围手术期临床分析

目的　探讨糖尿病对非体外循环冠状动脉旁路移植术 (OPCAB)的影响。　方法　 2 51例患者接受OPCAB ,其中糖尿病患者 (DM组 ) 71例 ,非糖尿病患者 (NDM组 ) 180例。单变量统计分析两组的术前危险因素和术后并发症。　结果　两组患者术后在监护室的时间 [DM组 (2 .4± 0 .3 )d ;NDM组 (2 .4± 0 .3 )d ;P =0 .3 86]、胸部切口并发症 (DM组 :5.7% ;NDM组 :3 .9% ;P =0 511)等方面差异无显著意义 ,两组患者术后严重并发症 :脑卒中 (DM组 :2 .8% ;NDM组 :1.7% ;P =0 .62 3 )、肾功能衰竭血液透析 (DM组 :2 .8% ;NDM组 :0 .5% ;P =0 .194)、心肌梗死 (DM组 :0 % ;NDM组 :0 5% ;P =1.0 0 0 )及死亡率 (DM组 :2 .8% ;NDM组 :1.1% ;P =0 .680 )差异无显著意义。　结论　糖尿病患者经适当控制病情以后 ,OPCAB可以如同非糖尿病患者一样安全地实施。     

非体外循环和体外循环冠状动脉旁路移植术生活质量比较

目的:用一个普适生活质量量表和一个疾病特异量表随机对照研究非体外循环和体外循环冠状动脉旁路移植术患者生活质量改变的情况。方法:应用健康标准化量表简短表格36(SF-36),西雅图心绞痛调查问卷(SAQ)分析研究2006-01-2010-10这5年间147例冠状动脉旁路移植术患者资料,其中非体外循环冠状动脉旁路移植术组96例、体外循环组51例。调查时间是术前1周,术后6～12个月。结果:术前两组患者问卷结果相似。术后6～12个月,SF-36问卷显示在生理职能、社会功能、精神健康等方面,非体外循环组优于体外循环组;SAQ问卷在心绞痛程度、心绞痛频率、生活质量方面,非体外循环组优于体外循环组。结论:术后6～12个月非体外循环较体外循环冠状动脉旁路移植术对患者生活质量改善更明显。     

A comparative analysis of intra-aortic balloon pump in off-pump patients undergoing coronary artery bypass grafting at different perioperative stages

Background Intra-aortic balloon pump(IABP) has been widely used at present.We can use it at different stages of perioperative period in off-pump coronary artery bypass grafting(CABG).However,when to used it was seldom confirmed.Methods From January 2008 to June 2012,the 89 coronary heart disease(CHD) patients accepted implantation of IABP at different stages of off-pump CABG,preoperative and postoperative ventricular systolic function,left ventricular remodeling situation and the changes of myocardial enzymes were evaluated.Results All the patients had left heart insufficiency and multivessel disease.Their postoperative left ventricular systolic function and ventricular remodeling were significantly improved while myocardial enzymes decreased with preoperative interventional implantation of IABP.The perioperative mortality was 7.86%(7 /89).No patients had complication of IABP.Conclusion Earlier IABP implantation at preoperation is useful to improve heart function,improve the tolerability of surgery,reduce the incidence of postoperative low cardiac output syndrome(LCOS) and decrease the mortality.     

Diabetes in patients undergoing coronary artery bypass grafting. Impact on perioperative outcome

Summary Diabetes mellitus is an established risk factor related to significant morbidity and mortality after coronary artery bypass grafting. Data on 9682 patients undergoing coronary artery bypass grafting either with (n=8917) or without cardiopulmonary bypass (off-pump coronary artery bypass grafting; n=765) were subjected to an univariate analysis to identify potential associations between diabetes mellitus and 26 a priori selected perioperative outcome variables. Those having a significant association with diabetes were then subjected to a stepwise logistic regression model to identify the impact of diabetes as compared to additional 22 different a priori chosen patient related risk factors and treatment variables. Prevalence of outcome variables independently associated with diabetes has been determined in the subgroup of diabetics undergoing coronary artery bypass grafting with cardiopulmonary bypass or off-pump coronary artery bypass grafting surgery to evaluate the effect of avoiding cardiopulmonary bypass on perioperative patient outcome. Diabetes mellitus was defined as glucose intolerance either treated dietary, with oral hypoglycemics or with insulin. According to this definition of diabetes mellitus we found an overall prevalence of 37.1% (coronary artery bypass grafting with cardiopulmonary bypass: 37.5%; off-pump coronary artery bypass grafting: 32.5%). Eleven outcome variables having a significant association with diabetes were identified. Diabetes could be identified as an independent predictor of postoperative delirium, renal dysfunction and respiratory insufficiency. Prevalence of these three variables was lower in diabetics undergoing offpump coronary artery bypass grafting as in those undergoing coronary artery bypass grafting with cardiopulmonary bypass surgery reaching statistical significance with regard to postoperative delirium and respiratory insufficiency. In conclusion, diabetes mellitus is a significant independent predictor for three postoperative outcome variables in coronary artery bypass surgery. Avoiding cardiopulmonary bypass in diabetics seems to have a beneficial effect.     

体外循环与非体外循环下冠脉旁路移植术后的血管桥通畅比较

目的：比较非体外循环下冠状动脉旁路移植术（OPCABG）与常规冠状动脉旁路移植术（CCABG）术后3-4年时血管桥的通畅率。方法：2003年1月-2004年12月间40例单独行冠状动脉旁路移植术（CABG）的患者资料回顾性地被分为OPCABG组和CCABG组。OPCABG组通过胸骨正中切口,在非体外循环心脏不停跳下完成CABG;CCABG组建立常规体外循环,心脏停搏下完成CABG。两组术前的一般情况无明显区别。利用多层螺旋CT（multislice spiral CT,MSCT）造影检查及CT图像后处理,研究两种术式各条血管桥的通畅情况。结果：CCABG及OPCABG组在左乳内动脉（LI MA）到前降支（LAD）的通畅率分别达到94.1%,94.4%,后降支（PDA）为88.2%,91.6%,钝缘支（包括对角支）的通畅率分别为88.9%,90.9%,静脉桥的通畅率为87.8%,88.0%,动脉桥的通畅率为85.7%,91.3%。各组间统计差别均无显著性。结论：OPCABG旁路血管桥的3-4年通畅率可以和CCABG相媲美.OPCAB治疗冠心病的初期结果显示可以减少术后并发症、减少患者术后呼吸机辅助时间和ICU留观时间、住院时间,降低住院费用,它的普及势在必然。     

高龄患者体外与非体外循环冠脉搭桥术对呼吸功能的影响

目的比较体外循环与非体外循环冠脉搭桥术对高龄患者呼吸功能的影响。方法择期行冠脉搭桥术高龄患者（>70岁）30例,其中14例行常规体外循环下冠脉搭桥术;16例行非体外循环冠脉搭桥术。测定两组手术前后不同时点呼吸功能指标动脉血氧含量（CaO2）和术后氧合指数（OI）,呼吸机支持时间,气管插管拔除后24h内自主呼吸频率和呼吸情况。结果两组术后各时点CaO2均较术前显著下降（P<0.05）,OI相应时点较术前显著增高。非体外循环冠脉搭桥术组术后各时点CaO2明显高于常规体外循环下冠脉搭桥术组（P<0.05）,而非体外循环冠脉搭桥术组术后各时点的OI值均显著低于常规体外循环下冠脉搭桥术组（P<0.05）,非体外循环冠脉搭桥术组呼吸机支持时间较短（P<0.05）,气管插管拔除后自主呼吸频率较平稳（P<0.05）。结论大于70岁患者行冠脉搭桥术其呼吸功能均受影响,非体外循环冠脉搭桥术对呼吸功能影响较小,优点较多,更适合高龄患者。     

体外循环与非体外循环冠状动脉旁路移植术早期疗效分析

目的:探讨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（OPCABG）早期疗效的差异。方法: 采集自2003年10月~2008年1月我院单纯冠状动脉旁路移植术5325例临床资料,分为CCABG组（343例）与OPCABG组（4 982例）。对两组患者各项术前因素、术中因素、手术死亡率及并发症进行比较。结果: OPCABG组实际手术死亡率（1.7％）明显低于CCABG组（6.7％）,P<0.01;术后二次开胸止血、肾功能不全等并发症的发生率及ICU停留时间、呼吸机辅助时间、术后住院时间都低于CCABG组（P<0.05,P<0.01）。风险调整后CCABG组手术死亡率仍高于OPCABG组6个百分点,术后并发症的发生率均略高于OPCABG组（P<0.05）。结论: CCABG与OPCABG早期临床疗效均令人满意,后者更好一些。     

Mid-term outcomes of off-pump versus on-pump coronary artery bypass graft surgery

OBJECTIVE:

To evaluate survival and readmissions to hospital for cardiac events or coronary revascularization (REVASC) in patients having off-pump (OPCAB) versus conventional on-pump (CCAB) coronary artery bypass graft surgery (CABG).

METHODS:

Of 11,368 consecutive patients undergoing isolated CABG between 1996 and 2002, 514 had OPCAB surgery. Using propensity scores, 503 CCAB patients were randomly matched to 503 OPCAB patients.

RESULTS:

There were no clinical or statistical differences between the two groups for any prognostic variable. However, OPCAB patients received significantly fewer distal anastomoses than the CCAB group (2.6±1.0 versus 3.1±1.0; P<0.001). There was no difference in operative mortality (OPCAB 1.0%, CCAB 1.4%; P=0.6), but the OPCAB group had significantly fewer operative strokes (0.2% versus 1.8%; P=0.01). Follow-up was 99.7% complete at 2.2±1.2 years (range 0 to 6 years). Twice as many OPCAB patients (n=24) required REVASC compared with the CCAB (n=11) group. The following five-year actuarial outcomes are presented for CCAB and OPCAB, respectively: survival: 77±6%, 76±8%, P=0.8; freedom from REVASC: 95±3%, 92±2%, P=0.02; and cardiac event-free survival: 76±5%, 62±8%; P=0.05. Cox regression revealed that OPCAB was a significant independent predictor of poorer freedom from REVASC (RR 2.2, 95% CI 1.0 to 4.6; P=0.04) and cardiac event-free survival (RR 1.6, 95%CI 1.1 to 2.2; P=0.02).

CONCLUSIONS:

The use of OPCAB remains controversial. These results, from this early experience, suggest that despite improved hospital outcomes, the lesser degree of REVASC raises concerns about the need for repeat revascularization in the OPCAB group.     

非体外循环冠状动脉旁路移植术中血糖调控的应用

目的 探讨非糖尿病患者非体外循环冠状动脉旁路移植术围术期血糖调控的效果。方法 将70例行OPCAB的非糖尿病患者随机分为2组,每组35例。分别接受胰岛素输注(试验组)或生理盐水输注(对照组),观察麻醉诱导前、搭桥前、搭桥后、关胸后、术后ICU1h、ICU6h、ICU12h、血糖值。结果 1.试验组与对照组相比,术后呼吸机使用时间(13.78±6.42vs19.02±9.74)、术后住院时间(19.54±5.72vs22.48±6.45)均显著缩短,术后心律失常发生率显著降低。2.试验组与对照组相比较,血糖在麻醉诱导前无统计学差异,而搭桥前、搭桥后、关胸后、ICU1h、ICU6h、ICU12h的血糖显著降低。结论 非糖尿病患者行OPCAB围术期高血糖可能影响预后,输注胰岛素输注可以有效控制血糖、改善雨后。     

Initial experience with off-pump coronary artery bypass grafting

Off-pump coronary artery bypass grafting (OPCAB) is clearly preferable for patients with extracardiac complications. The aim of this study was to evaluate the initial outcome of OPCAB, and its validity for patients with extracardiac complications. One hundred and fifty-seven consecutive coronary artery bypass graft (CABG) patients were divided into two groups: 30 OPCAB patients and 127 on-pump CABG patients. The early outcomes of the two groups were compared. Preoperatively, OPCAB patients had more extracardiac risk factors than on-pump CABG patients. There were no differences in age or cardiac function between the groups, but the off-pump group had a higher incidence of previous surgery, cerebrovascular disease, and renal failure. There were no differences in graft patency, stroke, or mortality between the two groups, even though the OPCAB patients had more risk factors than the on-pump patients. Our initial experience with OPCAB showed that it is acceptable for high-risk patients in view of the serious nature of their extracardiac condition. Received: April 12, 2001 / Accepted: August 17, 2001     

Beating-heart on-pump coronary artery bypass grafting vs. off-pump coronary artery bypass grafting: a systematic review and meta-analysis

BackgroundBeating-heart on-pump coronary artery bypass grafting (CABG), otherwise known as BH-ONCAB, can reduce myocardial injury by preserving native coronary blood flow while maintaining hemodynamic stability by the effective support of cardiopulmonary bypass (CPB). This study aimed to identify whether BH-ONCAB confers a survival, mortality, or morbidity benefit over off-pump CABG (OPCAB).MethodsA systematic literature review identified 18 studies incorporating 5,615 patients (1,548 BH-ONCAB and 4,067 OPCAB cases) who satisfied the inclusion criteria. Outcome measures were meta-analyzed using random-effects modeling. Between-study heterogeneity was investigated through quality assessment and risk of bias analysis.ResultsThe results demonstrated comparable early mortality and long-term survival between BH-ONCAB and OPCAB coronary revascularization with no significant statistical differences. The incidences of stroke, renal failure, blood loss, and arrhythmias were significantly higher in patients who underwent BH-ONCAB than patients who underwent OPCAB. However, BH-ONCAB conferred lower rates of incomplete revascularization and greater numbers of distal anastomoses.ConclusionsBH-ONCAB is a safe and comparable alternative to OPCAB in terms of early mortality and late survival. BH-ONCAB may confer particular advantages in preventing incomplete revascularization and allowing more distal anastomoses compared to OPCAB. However, BH-ONCAB was associated with more postoperative complications due to the use of CPB. Future work should focus on larger matched studies and multicenter randomized controlled trials to optimize our surgical revascularization strategies.