体外与非体外循环下冠状动脉搭桥治疗冠状动脉三支病变的对比研究

目的:对比研究体外与非体外循环下冠状动脉搭桥治疗冠状动脉三支病变的临床效果。方法:300例单纯冠状动脉多支搭桥患者分别进入常规体外循环下冠状动脉搭桥组(CCABG组,n=150例)和非体外循环冠状动脉搭桥组(OPCAB组,n=150例)。两组患者在心绞痛程度、合并慢性阻塞性肺病(COPD)、心肌梗死史和糖尿病、急诊手术和左主干(LM)病变等方面无显著性差异,但OPCAB组手术前有脑梗死史和肾功能异常患者的比例明显多于CCABG组(P均<0.05)。所有患者均采用胸骨正中切口。CCABG组在常规CPB心脏停跳下进行,OPCAB组用单根心包深吊线,引入一纱条,帮助暴露各冠状动脉分支,采用心脏局部固定器,辅以腔内分流栓,完成远端吻合。所有患者术终行桥血流定量测定。结果:OPCAB组无1例需转成CCABG。所有患者均在心脏侧壁和后壁区域搭桥。两组人均冠状动脉远端吻合数(OPCAB组:3.84±1.06,CCABG组:3.75±0.94)和再血管化指数相似;手术后呼吸支持时间、胸腔引流量和输血量OPCAB组明显少于CCABG组(P<0.05,P<0.01);OPCAB组呼吸功能不全和肾功能异常发生率低于CCABG(P均<0.05);两组围手术期心肌梗死、脑卒中、房颤发生率和手术病死率无统计学差异。结论:对比研究结果显示,OPCAB可用于冠状动脉三支血管病变,能达到与常规CCABG相似的完全性再血

A Comparative Study of on-pump and off-pump Coronary Bypass Surgery for Patients with Triple Vessels Disease

Objective:To make a comparative analysis of the clinical resul ts o f on-pump and off-pump coronary bypass surgery in patients with triple vessels disease. Methods:Consecutive 300 isolated multiple coronary artery bypass pati ents entered into off-pump coronary artery bypass (group OPCAB, n=150) or coron ary artery bypass with cardiopulmonary bypass (CPB) (group CCABG, n=150). Before surgery there was no significant difference between the two groups with regards to the degree of angina, history of myocardial infarction, with diabetes and le ft main disease and ejection fraction. Group OPCAB had more patients with histor y of stroke, and abnormal renal function than group CCABG pre-operatively(P< 0 .05). All patients had coronary bypass surgery through full sternotomy. Group o f CCABG underwent the support of CPB but Group OPCAB without. Single deep perica rdial stay suture with a sling snared down was used to expose the target coronar y vessels in group OPCAB, along with the stabilizers and coronary shunts. Medi- Stim Butterfly Flowmeter was used to measure the flow grafts in both groups. Res ults:No one in group OPCAB was needed to be converted into CCABG. The mean numb er of the distal anastomosis and the ICR (index of completeness of revasculariza tion) are similar in both groups. The respiratory support time, the chest tube d rainage and blood transfusion are less in group OPCAB than in group CCABG post- operatively ( P< 0.05, P< 0.01); Pulmonary dysfunction and abnormal renal functi on are less common in group OPCAB than in group CCABG post-operatively(both P< 0.05). There is no significant difference in the mortality and other morbiditi es (peri-opetative MI,stroke, atrial fibrillation). Conclusion:OPCAB can be ap plied to patients with triple coronary vessels disease and can achieve similar c ompleteness of revascularization, similar early surgical results with shorter re spiratory support, reduced transfusion requirement, less pulmonary dysfunction a nd abnormal renal function.