近端优先序贯技术在老年非体外冠状动脉循环旁路移植术中的应用

Proxlmn!- first sequential anastomosis techniques in off-pump coronary artery bypass grafting of the aged

目的探讨老年非体外冠状动脉旁路移植手术（OPCABG）中应用近端优先序贯技术的可行性及优越性。方法2008年1月至2012年10月期间，72例65岁以上老年患者接受OPCABG手术，回顾性对比分析各项临床资料。患者分2组，近端优先序贯吻合组（序贯组）和常规吻合技术组（对照组）。结果序贯组患者心肌缺血（90．48±2．43）min，对照组（105．83±4．64）min，差异有统计学意义（P〈0．01）。与对照组患者比较，序贯组ICU停留时间短（P〈0．05），术后输注红细胞量少（P〈0．05）。两组间肌酸激酶同工酶（CK-MB）指标，术后24、72h差异有统计学意义（P〈0．05）。两组间肌钙蛋白I（TnI）术后6、24及72h差异均有统计学意义（P〈0．05）。结论近端优先序贯技术较常规OPCABG技术对患者的心肌损伤小，是一种安全有效的手术方式。

Objective To assess clinical results between proximal- first sequential anastomosis technique （POPCAB） and conventional technique off-pump coronary artery bypass grafting（COPCAB） in 72 patients over 65 years old. Methods Between Jan 2008 and Oct 2012, 72 patients with multiple vessel coronary artery disease underwent off-pump coronary artery bypass grofting. They were divided into two groups, POPCAB and COPCAB groups. Preoperative and postoperative variables of two groups were compared. Results There were no significant difference in sex, age, history of acute myocardium infarction, hypertension, diabetes and number of bypass grafts between two groups. The ICU stay time in POPCAB group was less than in COPCAB group（P 〈 0.05）. There were lower ereatine kinase MB and cardiac trop I after operation in POPCAB group compared with COPCAB group（ P 〈 0.05 ）. Conclusion The results confirm that promixal-first sequential anastomosis technique re- mains a valuable option of surgical myocardial revaseularization, and may optimize the outcome in the aged.