重症糖尿病合并冠心病患者行冠状动脉旁路移植术的探讨

Effect of off-pump coronary bypass surgery on outcomes of patients with coronary heart disease patients who companied with severe diabetics

目的探讨合并重症糖尿病(DM)的冠心病患者行非体外循环冠状动脉旁路移植术(OPCAB)的效果及治疗方法。方法回顾性分析2005年1月至2008年6月行OPCAB患者中合并重症DM的病例32例,随机选择同期行OPCAB的非DM病例64例作为对照。结果围手术期死亡7例(21.88%),明显高于同期OPCAB患者病死率(2.1%)。20例随访1～3年,3例因心功能不全再次入院治疗,无再次心肌血运重建病例。结论对于合并重症DM患者行OPCAB应采取慎重态度,保守治疗应该被充分考虑。

Objective To evaluate the therapy strategy and effects of off-pump coronary bypass surgery in coronary heart disease patients who companied with severe diabetics. Methods A total of 32 patients with coronary heart dis- ease who companied with severe diabetics undergoing coronary bypass surgery were retrospectively studied from Jan. 2005 to Jun. 2008 in Beijing Anzhen Hospital. Results The incidence of perioperative mortality（30 days） of these patients was higher than that of patient without diabetics underwent off-pump coronary bypass surgery （OPCAB） （21.88% vs 2.1%, P 〈 0.05）. Clinical follow-up for 1 -3 years showed that three patients rehospitalized for heart failure and there was no revascularization. Conclusions We should take cautions to do the off-pump coronary bypass surgery in coronary heart disease patients who companied with severe diabetics. Medical therapy should be taken in consideration in these special population.