180例高危病例的冠状动脉搭桥术——停跳与不停跳手术的比较

Comparative effects of on-pump versus off-pump coronary bypass in 180 high-risk patients

目的比较体外循环冠状动脉搭桥手术(on-pumpcoronaryarteryby-passgrafting,(CABG)与不停跳冠状动脉搭桥手术(off-pumpcoronaryarterybypassgrafting,OPCAB)对高危手术病人术后死亡率、并发症发生率等的影响。方法从2002年1月至2003年11月,新加坡国立心脏中心共为180例高危冠状动脉粥样硬化性心脏病病人(欧洲心脏手术危险性评估系统Euroscore≥6分)行冠状动脉搭桥术,包括121例CABG(占67.2%)和59例OPCAB(占32.8%)。将两组病人术前、术中情况以及术后住院期间的死亡率、并发症发生率等分别进行比较。结果术后在血制品的应用、呼吸机辅助时间、呼吸功能不全的发生率、ICU滞留天数以及住院天数等方面,OPCAB均明显优于CABG。结论OPCAB对高危冠心病病例具有良好的可行性,与CABG相比,具有明显的优越性。

Objective： To compare the mortality and perioperative morbidity between off-pump and on-pump coronary artery bypass grafting （CABG） in a subset of high-risk patients. Methods： Between January 2002 and November 2003, 180 high-risk patients with Euroscores≥6 underwent CABG. 121 （67.2%0） of these patients underwent on-pump coronary surgery, while 59 （32.8%） were received off-pump coronary surgery. The general conditions before operation and the perioperative mortality and morbidity after operation were compared between the two groups. Results： Postoperatively, transfusion requirement, ventilation time, lung insufficiency rates, intensive care unit stay and total length of stay, all showed a highly significant benefit for the off-pump group. Conclusions： Off-pump CABG is safe and effective in high-risk patients, with results comparable with conventional on-pump CABG.