桡动脉桥血管应用于冠状动脉旁路移植术的围术期疗效分析

Perioperative Outcomes of Coronary Artery Bypass Grafting Using the Radial Artery

目的探讨桡动脉作为第二动脉桥血管对冠状动脉旁路移植术围术期手术疗效的影响。方法回顾性分析2011年8月至2012年4月沈阳军区总医院连续接受非体外循环冠状动脉旁路移植术175例患者的临床资料,175例患者随机分为两组,组1:75例,男49例,女26例;年龄(56.8±8.2)岁;应用桡动脉作为桥血管材料;组2:100例,男66例,女34例;年龄(57.7±8.1)岁;使用大隐静脉作为桥血管材料,不用桡动脉作为桥血管材料;两组患者左乳内动脉使用率均为100%。比较两组患者围术期心血管事件发生率及其它临床参数。结果所有患者术后30 d内均存活。两组患者手术时间、术后24 h胸腔引流量、术后住院时间比较差异无统计学意义(P>0.05)。术后重症监护时间、机械辅助通气时间虽然两组间差异无统计学意义,但组1较组2有减少趋势。术后因心功能不佳需较长时间心血管活性药物支持方面,两组间差异虽无统计学意义,但组2患者的比率高于组1[16%(16/100)vs.12%(9/75)]。组1患者术后无新发心肌缺血和因血流动力学不稳定而行主动脉内球囊反搏(IABP)辅助;组2有3例患者出现新发心肌缺血,新增2例IABP辅助。结论桡动脉作为桥血管取代部分大隐静脉,不仅并未增加围术期心血管事件的风险,反而在一定程度上有利于患者的恢复。桡动脉可更加广泛地应用于冠状动脉旁路移植术。

Objective To explore perioperative outcomes of coronary artery bypass grafting （CABG） using the radial artery as the second arterial graft. Methods Clinical data of 175 consecutive patients undergoing off-pump coronary artery bypass grafting （ OPCAB ） in General Hospital of Shenyang Military Command from August 2011 to April 2012 were retrospectively analyzed. All the 175 patients were divided into two groups. There were 75 patients including 49 male and 26 female patients with their age of 56.8 _＋ 8.2 years in group 1, who received radial artery as a graft vessel. There were 100 patients including 66 male and 34 female patients with their age of 57.7_ 8.1 years in group 2, who received great saphenous vein but not radial artery as the graft vessel. The use of left internal mammary artery as a graft vessel was 100% in both groups. Perioperative cardiovascular events and other clinical results were compared between the two groups. Results All the patients survived OPCAB and there was no 30-day death. There was no statistical difference in operation time, thoracic drainage within the first 24 hours after surgery or postoperative hospital stay between the two groups （P 〉 0.05 ）. Length of postoperative ICU stay and mechanical ventilation time of group 1 were shorter than those of group 2, although the difference was not statistically significant. The percentage of patients receiving prolonged postoperative inotropic therapy of group 2 was higher than that of group 1 ~ 16% （16/100） vs. 12% （9/75）], although the difference was not statistically significant. Postoperatively, there was no patient in group 1 who had new-onset myocardial ischemia or received intra-aortic balloon pump （IABP） support for hemodynamic instability. In group 2,3 patients had new-onset myocardial ischemia and 2 patients received IABP support after OPCAB. Conclusion Radial artery can partly replace great saphenous vein as a graft vessel for OPCAB, which does not increase the risk of perioperative cardiovascular events but is beneficial for postoperative recovery to some degree. Radial artery can be more extensively used in CABG.