高危患者行非体外循环与体外循环冠状动脉旁路移植术早期临床结果的对比分析

目的比较单纯非体外循环冠状动脉旁路移植术（OPCAB）和单纯体外循环冠状动脉旁路移植术（CCABG）在高危患者中的早期临床情况。方法高危患者的定义是其由欧洲心脏手术风险评估系统（VuroSCORE）得出的评分≥5分。将我院1999年1月至2003年12月所行197例高危CCABG和318例高危OPCAB两组患者的早期临床情况进行对比分析。结果OPCAB组和CCABG组EuroSCORE分值差异无统计学意义（6．1±1．2比6．3±1．4,P〉0．05）。OPCAB组年龄为（71．1±6．0）岁,高于CCABG组的（60．2±8．5）岁,P〈0．01。OPCAB组外周血管病患病率（47．8％）高于CCABG组（23．4％,P〈0．01）。OPCAB组手术死亡率1．6％（5／318）]低于CCABG组6．1％（12／197）,P〈0．01];术后恢复室（ICU）总时间（90±169）h]少于CCABG组（126±187）h,P〈0．05];术后辅助通气总时间（21±45）h]少于CCABG组（54±169）h,P〈0．01];术后行主动脉内球囊反搏（IABP）比例（2．5％）、术后因心脏问题再次手术比例（1．9％）、术后脑卒中比例（0．3％）及术后心跳骤停比例（2．8％）均低于CCABG组（分别为10．2％、5．6％、2．5％、6．6％,P〈0．01或P〈0．05）。结论在危险评分类似的高危患者中,与CCABG相比,OPCAB能够减少术后ICU时间和术后辅助通气时间,降低手术死亡率和术后并发症的发生率。但目前尚不能替代CCABG。

The short-term outcomes in selected high-risk patients underwent off-pump or on-pump coronary artery bypass grafting

OBJECTIVE: To compare the short-term outcomes in selected high-risk patients underwent off-pump coronary artery bypass grafting (OPCAB) or on-pump conventional coronary artery bypass grafting (CCABG). METHODS: Comparative analysis was made between 318 high-risk patients underwent OPCAB between January 1999 to December 2005 and 197 high-risk patients underwent CCABG between January 1999 to December 2003 and EuroSCORE was > or = 5 in all patients. RESULTS: EuroSCORE was similar between the two groups (6.1 +/- 1.2 vs. 6.3 +/- 1.4 per patient). The patients in OPCAB group were significantly older (71.1 +/- 6.0) years vs. (60.2 +/- 8.5) years, P < 0.01] and had more peripheral vascular diseases (47.8% vs. 23.4%, P < 0.01) than that in CCABG group. The OPCAB group included more patients with left ventricular ejection fraction (LVEF) > or = 50% (84% vs. 60.4%, P < 0.01) compared to CCABG group. Mean grafts per patient was 3.0 +/- 0.8 in OPCAB group and 3.6 +/- 0.9 in CCABG group (P < 0.01). Operative mortality was 1.6% (5/318) in OPCAB group and 6.1% (12/197) (P < 0.01). The total Intensive Care Unit (ICU) time was (90 +/- 169) hours for OPCAB patients and (126 +/- 187) hours for CCABG patients (P < 0.05). The total ventilator support time was (21 +/- 45) hours for OPCAB and (54 +/- 170) hours for CCABG patients (P < 0.01). Intro-Aortic Balloon Pump (IABP) rate (2.5% vs. 10.2%, P < 0.01), rate of re-operation for cardiac reasons (1.9% vs. 5.6%, P < 0.01), rate of cerebral vascular accident (CVA) (0.3% vs. 2.5%, P < 0.05) and cardiac arrest rate (2.8% vs. 6.6%, P < 0.05) were all less in OPCAB group compared to CCABG group. CONCLUSION: Compared to CCABG, OPCAB significantly reduces post operation ICU time, ventilator support time, operative mortality and operative morbidity in selected high-risk patients.