序贯式不停跳冠脉搭桥与非序贯式不停跳冠脉搭桥的对比研究

目的：通过多项指标对比序贯式不停跳冠脉搭桥与非序贯式不停跳冠脉搭桥临床疗效。方法随机选取于2009年1月至2015年1月在我院接受冠状动脉旁路移植手术的非序贯式不停跳冠脉搭桥手术患者与序贯式不停跳冠脉搭桥手术患者各28例为研究对象，总计56例。将行非序贯式不停跳冠脉搭桥患者记为对照组，行序贯式不停跳冠脉搭桥患者记为观察组。对比两组术后1天(A1)以及术后2天(A2)的心肌肌钙蛋白I(cTnI)浓度、肌酸激酶-同工酶(CK-MB)活性、氨基酸末端前体脑钠肽(NT-proBNP)浓度以及桥血管使用数目、手术时间、出血量、住院费用。结果行序贯式不停跳冠脉搭桥患者组(观察组)在A1、A2时刻的cTnI、CK-MB、NT-proBNP低于行非序贯式不停跳冠脉搭桥患者组(对照组)。此外，观察组在桥血管使用数目、手术时间、出血量、住院费用显著低于对照组。结论序贯式OPCABG术对心肌损伤的程度小于非序贯式OPCABG，并且序贯式OPCABG术桥血管使用少，手术时间短，住院费用更低，尤其对于主动粥样斑块较多，桥血管缺乏，基础状态较差的病人优于非序贯式OPCABG,极大地增加了OPCABG手术适应症。

Comparative Study of Sequential Type of OPCABG and Non-sequential Type of OPCABG

Objective The clinical effect of sequential type of OPCABG and non-sequential type of OPCABG was compared by a number of indicators.Methods From 2009 January to 2015 January underwent coronary artery bypass graft operation in our hospital were randomly selected for sequential type of OPCABG and non-sequential type of OPCABG patients all 28 patients as research object, a total of 56 cases. According to different operation modes, the non sequential OPCABG patients were recorded as the control group, and the sequential OPCABG was recorded as the observation group, compared the two groups of anesthesia induced by 5Min after operation (T0), 1d after operation (T1) and 2d (T2) of myocardial troponin I (cTnI) concentration, creatine kinase isoenzyme (CK-MB) activity, the concentration of blood glucose and the number of vessels used in the bridge, operation time, bleeding volume, hospitalization expenses. Results Two groups of patients with cTnI, CK-MB, NT-proBNP on T0 moment, any time the level of IL-6 were no difference (P>0.05), in T1, T2 moments CTnI, CK-MB, NT-proBNP were lower than the control group In addition, the use of the number of the observation group in the bridge, the operation time, blood loss, hospitalization costs were signiifcantly lower than the control group.Conclusion The degree of myocardial injury in the sequential OPCABG is less than the non sequential OPCABG. The use of bridge vessel in sequential OPCABG is less, the operation time is shorter, the cost of hospitalization is lower, especially for the the patients with Aortic atherosclerosis, and the patients with lack of the bridge vessel, which greatly increased the OPCABG surgical indications.