冠心病合并颈动脉狭窄患者冠状动脉旁路移植术后远期结果

Long-term outcome of patients with coronary heart diseases and carotid arteriostenosis after coronary artery bypass surgery

目的：分析不同术式（心脏停跳或不停跳）对行冠状动脉旁路移植术（CABG）后患者脑卒中发生率和生存率的影响。方法解放军总医院心血管外科2003年6月至2013年6月冠心病合并颈动脉狭窄的159例患者，其中男118例，女41例，年龄为（67.0±7.5）岁，根据心脏是否停跳分为停跳（on-pump）组及不停跳（off-pump）组，并对两组患者行CABG后的脑卒中发生率和生存率进行回顾性分析。结果随访146例，随访率93.6%，随访时间6～120（46.3±25.3）个月，10例术后出现神经系统症状，其中2例脑出血，8例脑梗死。17例死亡（4例脑部并发症，1例食管癌，1例肺癌，11例为心源性），平均死亡时间为术后41（4～72）个月。停跳组患者术后脑卒中发生率及生存率与不停跳组相比差异无统计学意义（P＞0.05）。结论心脏是否停跳对冠心病合并颈动脉狭窄患者术后脑卒中发生率和生存率无明显影响。

Objective To investigate the effect of on-pump and off-pump procedures on postoperative cerebral complications and survival rate after coronary artery bypass grafting （CABG）. Methods From June 2003 to June 2013, a total of 159 patients [（67.0±7.5） years old, 118 males and 41 females] with carotid arteriostenosis and coronary heart diseases, accepted isolated CABG in our department. They were divided into on-pump group （n=95） and off-pump group （n=64）. The prevalence of postoperative cerebral complications and the survival rate after CABG were compared and retrospectively analyzed. Results Follow-up was done for 146 patients with a rate of 93.6%, and a duration of （46.3±25.3） months, ranging from 6 to 120 months. Ten patients had neurological symptoms, including 2 of cerebral hemorrhage and 8 of stroke. Seventeen patients died during the follow-up （4 due to cerebral complications, 1 esophagus cancer, 1 lung cancer, and 11 cardiogenic reasons） within average 41 months postoperatively （ranging from 4 to 72 months）. There was no statistical difference in prevalence of postoperative cerebral complications and the survival rate between on-pump and off-pump groups （P〉0.05）. Conclusion On-pump and off-pump procedures have no significant difference in the effect on postoperative cerebral complications and survival rate in the patients with carotid arteriostenosis and coronary heart diseases.