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Received:December 04, 2019 Published Online:August 20, 2020
Received:December 04, 2019 Published Online:August 20, 2020
中文摘要: 目的 比较非体外循环下冠状动脉旁路移植术(OPCABG)与常规体外循环下冠状动脉旁路移植术(ONCABG)在三支冠脉狭窄性心脏病患者中的应用效果。方法 回顾性分析2016年3月至2018年3月阜外心血管病医院行单纯冠状动脉旁路移植术治疗冠状动脉狭窄性心脏病患者共80例的资料,其中45例采用ONCABG作为对照组,另35例接受OPCABG作为观察组。近期指标包括手术时间和ICU滞留时间、桥血管平均血流量(MF)和搏动指数(PI)、血浆B型利钠肽(BNP)和C反应蛋白(CRP)水平,以及30 d内并发症发生率。随访时间15~36个月,中位随访时间25个月,远期指标包括总生存率、心脏相关死亡率、桥血管通畅率和血运再重建率。结果 与对照组相比,观察组手术时间、ICU滞留时间短,动脉桥和静脉桥MF值增加,PI值降低,血浆BNP和CRP水平下降,30 d内并发症总发生率减少(P<0.05,P<0.01)。两组随访总生存率和心脏相关死亡率比较无统计学差异(P>0.05),但观察组桥血管通畅率高于对照组,血运再重建率低于对照组(P<0.05)。结论 OPCABG较ONCABG对机体循环干扰更小,术后恢复更快,应用于三支冠脉狭窄性心脏病患者能够明显增加桥血管血流,降低围术期应激和炎症反应,可减少近期并发症和远期死亡率,提高生存率和桥血管通畅率,减少二次手术风险。
中文关键词: 非体外循环下冠状动脉旁路移植术 三支冠脉狭窄性心脏病 桥血管 并发症
Abstract:ObjectiveTo compare the effects of off-pump coronary artery bypass grafting(OPCABG) and routine on-pump CABG(ONCABG) on three-vessel coronary heart disease with stenosis patients.MethodsEighty patients with coronary artery stenosis receiving CABG from March 2016 to March 2018 were enrolled in a retrospective study and divided into observation group (OPCABG group,n=35) and control group (ONCABG group,n=45).The short-term indicators including operation time,ICU retention time,mean blood flow velocities (MF),pulsation index (PI),plasma B-type natriuretic peptide (BNP),CRP levels and incidence of complications within 30 days were observed.The follow-up time ranged from 15 to 36 months,with an average of 25 months in two groups.Long-term indicators including overall survival rate,cardiac-related mortality,patency rate of bridging vessels and revascularization rate were observed and compared between two groups.ResultsCompared with control group,MF values of arterial and venous bridges increased,the operation time and ICU retention time,PI value,levels of plasma BNP and CRP and incidence of complications decreased in observation group (P<0.05,P<0.01).There were no significant differences in overall survival rate and cardiac-related mortality rate during follow-up between two groups (P>0.05).However,the patency rate of bridge blood vessels in observation group was statistically higher than that in control group,and the revascularization rate was lower than that in control group(P<0.05).ConclusionsCompared with ONCABG,OPCABG has less interference on the circulation of the body and quicker recovery for patients after operation.In the patients with complex three-vessel coronary stenosis heart disease,OPCABG has more advantages in increasing blood flow of bridging vessels,reducing perioperative stress and inflammatory reaction,short-term complications and long-term mortality,improving survival rate and patency rate of bridging vessels and decreasing secondary operation risk.
keywords: Off-pump coronary artery bypass grafting Three-vessel coronary stenosis heart disease Bridge vessels Complications
文章编号: 中图分类号: 文献标志码:A
基金项目:北京市科技计划课题项目(Z1511000039151)
Author Name | Affiliation |
ZHAO Yu-chen,WANG Cheng,XU Dong-hui,LYU Feng | Department of Cardiac Surgery,Fuwai Cardiovascular Hospital of Chinese Academy of Medical Sciences,Beijing 100037,China |
Author Name | Affiliation |
ZHAO Yu-chen,WANG Cheng,XU Dong-hui,LYU Feng | Department of Cardiac Surgery,Fuwai Cardiovascular Hospital of Chinese Academy of Medical Sciences,Beijing 100037,China |
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