合并糖尿病患者不停跳冠脉搭桥中腔镜获取大隐静脉的临床研究

Comparative study of endoscopic saphenous vein harvesting in off-pump coronary artery bypass grafting between patients with and without diabetic

目的 探讨合并糖尿病（DM）患者心脏不停跳冠状动脉旁路移植术（OPCAB）中腔镜微创获取大隐静脉（EVH）的临床效果及相关并发症.方法 回顾性分析2011年11月至2014年11月本院行OP-CAB中采用EVH制备大隐静脉桥血管（SVG）714例的临床资料,其中合并DM患者269例、非DM患者445例.观察两组患者术中SVG弃用率、血流量及PI值,术后切口感染、愈合不良、下肢局部血肿、下肢伤口疼痛等并发症发生率,CT冠脉造影随访两组部分患者近中期SVG通畅率.结果 DM、非DM两组比较：围术期总死亡3.0％比2.0％（P＞0.05）;术中SVG弃用率4.0％比2.0％（P＜0.05）,SVG平均血流量（17.36±11.24）ml/min比（19.85±9.17）ml/min （P＞0.05）,PI值2.78±2.37比2.16±4.21 （P＞0.05）;术后切口感染及愈合不良率0.8％比0.5％（P＞0.05）;下肢局部血肿率5.4％比3.9％（P＞0.05）,术后3d疼痛视觉类比评分（VAS）0.53±1.71比0.46±2.63 （P＞0.05）,下肢麻木异常感率11.9％比6.4％（P＜0.05）,1周后下肢水肿率8.4％比8.5％（P＞0.05）;术后CT冠脉造影随访SVG通畅率分别为6个月33/35比35/37,94.2％比94.5％（P＞0.05）,1年31/36比33/36,86.1％比91.6％（P＞0.05）.结论 合并DM患者应用EVH技术获取SVG有良好的临床效果,在不影响SVG近期通畅率前提下下肢并发症减少.

Objective To compare endoscopic saphenous vein harvesting （EVH） in off-pump coronary artery bypass grafting（OPCAB） between patients with and without diabetic. Methods The SV was harvested using EVH method in 714 patients who underwent OPCAB in our department between Dec 2011 and Dec 2014. Which combined the DM patient 269 cases, 445 cases of patients without DM, observe two groups of patients with deprecated rate of SVG, intraoperative SVG blood flow and the value of PI, postoperative incision infection, poor healing, lower limb local hematoma and lower limb wound complications such as pain. SVG potency rate of part patients were follow-up by CT coronary angiography. Results Compare to the two groups of patients with DM and without DM, the perioperative death 3.0% vs 2.0% （P〉0.05）. The deprecated SVG of patients were 4.0% vs 2.0%（P〈0.05 ）. The blood flow （ 17.36±11.24 ）ml/min vs （ 19.85±9.17 ）ml/min （P〉0.05, PI 2.78±2.37 vs 2.16±4.21 （P〉0.05）. The incision infection and poor healing 0.8% vs 0.5%（P〉0.05）. The lower limb local hematoma 5.4% vs 3.9%（P〉0.05）. The visual pain analogue scale（VAS） 3 days after operation 0.53±1.71 vs 0.46±2.63（P〉 0.05 ）. The numbness of lower limb 11.9% vs 6.4% （P〈0.05）. The Edema of the legs 7 days after operation 8.4%vs 8.5%（P〉0.05）. The SVG patency rate was 33/35 vs 35/37, 94.2% vs 94.5%（P〉0.05） in 6 moons after operation, 31/36 vs 33/36, 86.1% vs 91.6%（P〉0.05） in 1 year after operation. Conclusion EVH technology for SVG in the patients combined DM has good clinical effect of the perfect recent SVG patency and low postoperative limb complications.