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。

A comparative study on grafts′ patency after on-pump and off-pump coronary artery bypass surgeries

Objective： To compare the grafts＇ patency rate after off-pump coronary artery bypass grafting （OPCABG） and conventional coronary artery bypass grafting （CCABG） at 3-4 years follow-up. Methods.. Between January 2003 and December 2004, 76 patients with coronary artery disease underwent coronary artery bypass grafting by one surgeon. They were divided into two groups, OPCABG group： 20 cases underwent CABG with off-pump and beating heart; CCABG group： 20 cases underwent conventional CABG with extra corporeal circulation. The grafts＇ patency rate between two groups was studied by multislice spiral CT （MSCT） . Results： The number of bypass grafts of OPCABG group and CCABG group was （2.2±0. 8） grafts, （3.1±0. 6） grafts respectively. The grafts＇patency rate of OPCABG group and CCABG group was 94.1%, 94. 4% in grafts＇ linked LIMA to LAD, and the rate was 88.2%, 91.6% in PDA, and 88. 9%, 90. 9% in OM. The great saphenous vein grafts＇ patency rate was 87. 8% ： 88. 0%,and the arterial grafts＇ patency rate was 85.7%, 91.3% in the two groups （P〉0.05 all）. Conclusion： The grafts＇ patency rate of OPCABG has almost the same excellent result with which of CCABG. Patients with coronary disease underwent OPCABG have less operative morbidity, assisted respiratory time, ICU stay, hospitalization stay and hospitalization cost than those of CCABG. The pervasion of OPCAB is on the way.