"分站式"杂交冠状动脉血运重建术对冠状动脉多支血管病变患者近远期疗效的影响

The impact of " staging" hybrid coronary artery revascularization on the short-and long-term efficacy of patients with multiple coronary artery lesions

目的探讨"分站式"杂交冠状动脉血运重建术(HCR)对冠状动脉多支血管病变患者近远期疗效的影响。方法采取回顾性病例对照研究方法。选取保定市第二中心医院2017年1月至2018年10月收治的80例冠状动脉多支血管病变患者,根据手术方式的不同分为两组,其中40例患者行"分站式"HCR治疗,设为HCR组,40例患者行非体外循环冠状动脉旁路移植术(OPCAB)治疗,设为OPCAB组。比较两组围手术期相关指标、围手术期严重并发症发生情况。分别于术前及术后48 h检测受试者血清心肌损伤标志物水平,包括心脏型脂肪酸结合蛋白(H-FABP)、心肌肌钙蛋白I(cTnI)。对所有对象进行至少为期3年的追踪随访,统计其主要不良心脑血管事件(MACCE)发生情况。结果HCR组搭桥手术时间、机械通气时间、重症监护病房(ICU)停留时间、总住院时间均少于OPCAB组(均P<0.05),切口长度小于OPCAB组(P<0.05),术中出血量、术后24 h引流量、输红细胞量、输血浆量均少于OPCAB组(均P<0.05)。两组术后48 h血清H-FABP、cTnI水平均较术前显著升高(均P<0.05),但均以OPCAB组上升更显著(均P<0.05)。HCR组围手术期严重并发症发生率为2.50%(1/40),与OPCAB组[20.00%(8/40)]相比显著更低(P<0.05)。术后随访3年内,HCR组MACCE发生率为12.50%(5/40),OPCAB组为22.50%(9/40),两组远期MACCE发生率比较差异无统计学意义(P>0.05)。结论"分站式"HCR治疗冠状动脉多支血管病变可获得较为理想的手术效果,与OPCAB相比,其近期疗效更为显著,且远期疗效相当。

Objective To investigate the impact of"staging"hybrid coronary artery revascularization(HCR)on the short-and long-term efficacy of patients with multiple coronary artery lesions.Methods A retrospective case-control study was conducted.Eighty patients with multiple coronary artery lesions admitted to the Baoding Second Central Hospital from January 2017 to October 2018 were selected and divided into two groups according to different surgical methods.Forty patients were treated with"staging"HCR and were designated as the HCR group,and 40 patients were treated with off-pump coronary artery bypass grafting(OPCAB)and were designated as the OPCAB group.The perioperative related indicators and perioperative serious complications were compared between the two groups.The serum myocardial injury marker levels were detected preoperatively and 48 hours postoperatively,including heart-type fatty acid binding protein(H-FABP)and troponin I(cTnI).All subjects were followed up for at least 3 years to calculate the incidence of major adverse cardiovascular and cerebrovascular events(MACCE).Results The bypass surgery time,mechanical ventilation time,ICU stay time,and total hospital stay time in the HCR group were all less than those in the OPCAB group(all P<0.05),and the incision length in the HCR group was shorter than that in the OPCAB group(P<0.05).The intraoperative bleeding volume,postoperative 24-hour drainage volume,red blood cell transfusion volume,and plasma transfusion volume in the HCR group were all less than those in the OPCAB group(all P<0.05).Forty-eight hours after surgery,the serum H-FABP and cTnI levels in both groups were significantly higher than those preoperatively(all P<0.05),but the increase was more significant in the OPCAB group(all P<0.05).The perioperative serious complication rate in the HCR group was 2.50%(1/40),which was significantly lower than that in the OPCAB group[20.00%(8/40)](P<0.05).During the 3-year follow-up after surgery,the MACCE incidence in the HCR group was 12.50%(5/40),and that in the OPCAB group was 22.50%(9/40).There was no significant difference in the long-term MACCE incidence between the two groups(P>0.05).Conclusions"Staging"HCR treatment for multiple coronary artery lesions can achieve ideal surgical results.Compared with OPCAB,its short-term efficacy is more significant,and long-term efficacy is equivalent.