摘要
目的比较EuroSCORE≥7分的高危冠心病患者体外和非体外循环冠状动脉旁路移植手术治疗冠状动脉旁路移植效果的优劣。方法2008年9月至2011年3月，145例EuroSCORE≥7分冠心病患者以抽签方式随机分为体外循环组（on-pump组，71例）和非体外循环组（off-pump组，74例），on-pump组17例患者自愿选择非体外循环手术、6例未完成术后随访，均予以剔除；off-pump组2例选择体外循环手术、3例术中转on-pump、3例未完成术后随访，均予以剔除。最终114例冠状动脉旁路移植冠心病患者入选，on-pump组48例，off-pump组66例。收集患者术前、术中及围手术期详细资料。术后进行1个月随访。结果两组术前临床资料差异无统计学意义。两组乳内动脉应用率、正性肌力药物应用和IABP辅助方面相似，P〉0．05。而on-pump组与off-pump组相比，手术时间较长，但旁路移植支数更多，再血管化率更高[（3．71±0．55）支对（2．82±0．39）支]，P〈0．05。两组在围手术期病死率和多种术后并发症方面差异无统计学意义，P〉0．05。on-pump组比off-pump组术后24h胸腔引流量[（875．0±134．2）ml对（589．4±102．5）m1]及输血量[（656．3±84．4）ml对（433．3±62．9）m1]明显增多，P〈0．05。术后1个月两组心功能、心绞痛症状及心脏超声指标，组间相比差异无统计学意义，P〉0．05。结论高危冠心病患者，与OPCAB相比，on-pumpCABG并未增加术后肾功能衰竭、神经系统并发症及肺损伤的发生，而再血管化更完全，但缺点在于术后出血多、血制品使用多。
Objective Analysis the clinical data of high-EuroSCORE 114 patients due to coronary surgery to elucidate the surgical advantages between on-pump and off-pump CABG. Methods From September 2008 to March 2011, 114 high- EuroSCORE patients due to coronary surgery were randomly divided into off-pump group 48, and on-pump group 66 cases. Pre- operative, intra-operative and peri-operative clinical data of all the patients were collected. All patients were followed up for 1 month postoperatively. Results The baseline of the two groups had no significant difference. Application of internal mammary artery, positive inotropic drugs and IABP assistance between the two groups were similar, P 〉 0.05. Compared with the off- pump group, patients in on-pump group had longer operation time, but more graft counts and a higher rate of revascularization [ （ 3.71 ± 0. 55 ） grafts vs. （ 2. 82 ± 0. 39 ） grafts ], P 〈 0.05. There were no significant differences of peri-operative mortality and post-operative complications between the two groups, P 〉 0. 05. The patients in on-pump group had more post-operative chest drainage in the first 24 hours[ （875.0 ±134. 2）ml vs. （589. 4 ±102. 5）ml] and blood transfusion[ （656. 3 ±84. 4）ml vs. （433.3 ±62.9） ml] compared with the off-pump group, P 〈0.05. The data of 1-month follow up demonstrated that echo- cardiographic data, NYHA and symptoms of angina of the two groups had no significant difference, P 〉 0. 05. Conclusion Compared with OPCAB, CCAB did not increase postoperative renal failure, neurological complications and lung injury in high- risk patients, but had more complete revascularization. The disadvantage of CCAB was postoperative bleeding, blood products
出处
《中华胸心血管外科杂志》
CSCD
北大核心
2012年第6期352-355,共4页
Chinese Journal of Thoracic and Cardiovascular Surgery
