摘要
目的分析合并糖尿病对双侧乳内动脉(BIMA)冠状动脉旁路移植术(CABG)手术效果的影响。方法 2015年12月至2017年8月,我科应用BIMA行CABG的患者共182例,其中男153例、女29例,年龄(56.5±6.8)岁。按是否合并糖尿病进行分组,并应用倾向评分匹配进行配对,分为糖尿病组(n=66)和无糖尿病组(n=66)。其中糖尿病组男53例、女13例,年龄(57.8±7.2)岁;无糖尿病组男56例、女10例,年龄(56.3±6.0)岁。回顾性分析两组术中情况、术后并发症及术后3个月复查冠状动脉计算机断层扫描血管造影(CTA)的情况,并分析糖化血红蛋白(HbA1c)对上述指标的影响。结果倾向评分匹配后糖尿病组和非糖尿病组的各项术前指标差异无统计学意义。术后两组胸骨切口并发症发生率差异无统计学意义(P=0.466)。术后3个月冠状动脉CTA提示两组乳内动脉(IMA)和大隐静脉(SVG)通畅率差异无统计学意义(P=0.730、0.684)。术前HbA1c异常者54例,其术后胸骨切口并发症发生率显著高于HbA1c正常组(P=0.006)。出现胸骨切口并发症者HbA1c水平显著高于无胸骨切口并发症者(P=0.016)。结论合并糖尿病并不增加胸骨切口并发症等围手术期并发症,不应成为应用BIMA CABG的顾虑。对合并糖尿病患者,应注意将糖化血红蛋白控制在正常水平。
Objective To evaluate the influence of diabetes on coronary artery bypass graft(CABG) surgery using bilateral internal mammary artery(BIMA). Methods From December 2015 to August 2017, 182 patients(153 males, 29 females, age of 56.5±6.8 years) underwent CABG using BIMA. The propensity score was used to create matched diabetes(n=66) and non-diabetes(n=66) cohorts. The operative data, post-operative outcomes and coronary computed tomographic angiography(CTA) of the diabetes group(53 males, 13 females, age of 57.8±7.2 years) and the non-diabetes group(56 males, 10 females, age of 56.3±6.0 years) were analyzed retrospectively. Results There was no peri-operative mortality. There was no difference in operative sternal wound complication(P=0.466), or graft patency(P=0.730 for internal mammary arteries and 0.684 for saphenous vein grafts) between the matched diabetes and the non-diabetes groups. However, patients with elevated glycated hemoglobin(HbA1 c)(n=54) had more sternal wound complications(P=0.006). The level of Hb1 Ac of the patients with sternal wound complication was significantly higher than that of the patients without sternal wound complication. Conclusion BIMA grafting may be performed routinely even in diabetic patients, without increased complications. However, elevated HbA1 c level should be avoided to reduce sternal wound complication.
作者
仲肇基
郑哲
王小啟
高歌
李林林
樊红光
李浩杰
ZHONG Zhaoji;ZHENG Zhe;WANG Xiaoqi;GAO Ge;LI Linlin;FAN Hongguang;LI Haojie(Department of Cardiovascular Surgery,Fuwai Hospital,Chinese Academy of Medical Science,Beijing,100037,P.R.China.)
出处
《中国胸心血管外科临床杂志》
CAS
CSCD
2018年第12期1038-1042,共5页
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
基金
国家重点研发计划项目(2016YFC1302000)
关键词
冠状动脉旁路移植术
双侧乳内动脉
糖尿病
Coronary artery bypass graft
bilateral internal mammary artery
diabetes
