不停跳冠状动脉旁路移植术在左主干病变病人中的应用

Off-pump coronary artery bypass graft surgery in the patients with left main coronary artery stenosis

目的探讨不停跳冠状动脉旁路移植术(OPCAB)在左主干病变病人中应用的可行性和特点。方法 2002年5月至2006年5月,97例伴有左主干病变的冠心病病人施行了 OPCAB,同期为86例伴有左主干病变的冠心病病人行体外循环下的冠状动脉旁路移植术(CABG)。对两组病人术前、术后的临床资料进行对比分析。结果 OPCAB 和 CABG 组术前平均年龄(68.1±4.9)岁对(64.3±6.5)岁,P<0.05;术前慢性阻塞性肺疾病史10.3%对2.3%,P<0.05;术前肌酐高于正常者5.2%对0,P<0.05;术前脑梗塞病史12.4%对3.5%,P<0.05。术后 OPCAB 和 CABG 组病死率为1.03%对1.16%,P=0.93;房颤发生率14.4%对27.9%,P=0.02。结论对伴有左主干病变的冠心病病人行 OPCAB 临床效果良好。

Objective To investigate and determine whether patients with left main coronary artery stenosis could undergo offpump coronary bypass and compare the results to those using the conventional method. Methods A retrospective review was carried out for patients with left main coronary artery stenosis who underwent isolated off-pump and on-pump CABG at Beijing Chaoyang Hospital between May 2002 and May 2006. We studied in detail their preoperative and postoperative data in order to compare the outcomes of both group. Results The off-pump group consisted of 97 patients with a mean age of 68.1 years, and the on-pump group consisted of 86 patients with a mean age of 64.3 years, the frequency of the preoperative cerebral vascular accidents （12.4% vs. 3.5%, P = 0.03）, COPD （10.3% vs. 2.3%, P=0.03）, renal dysfunction （5.2% vs. 0, P =0.03） was significantly different between the two groups. The frequency of hospital death was 1.03 % in off-pump group and was 1.16% in on-pump group （ P = 0.93）. The frequency of postoperative atrial fibrillation was significantly fewer in off-pump group （ 14.4% vs. 27.9 %, P = 0.02）. Conclusion Off-pmnp coronary artery bypass graft surgery in the patients with left main coronary artery stenosis is a safe and effective alternative to the conventional method with the same or better early results.