择期分站式杂交手术与非体外循环冠状动脉旁路移植治疗冠状动脉多支血管病变的对比研究

Comparison Between Two-staged Hybrid Procedure and Off-pump Coronary Artery Bypass for Multiple Coronary Artery Revascularization

目的探讨择期分站式杂交（Hybrid）手术治疗冠状动脉多支血管病变的效果。方法选取2012年12月～2013年12月因冠状动脉多支血管病变在我院心脏中心行择期分站式Hybrid手术30例（Hybrid组）,按手术时间、年龄、性别、术前心功能状态、血管病变程度等从同期择期非体外循环冠状动脉旁路移植（off-pump coronary artery bypass,OPCAB）手术患者数据库中1∶1抽取30例（OPCAB组）,进行回顾性比较。所有患者术后3个月时采用电话问卷方式进行随访。结果Hybrid组手术时间（124.8±22.2）min,明显短于OPCAB组（211.8±28.2）min（t=13.277,P=0.000）;Hybrid组术中出血量（144.5±117.1）ml,明显少于OPCAB组（480.0±261.3）ml（t=6.418,P=0.000）,且Hybrid组术后输血量和输血浆量亦明显少于OPCAB组（P〈0.05）。Hybrid组术后呼吸机时间[（8.3±4.6）h vs.（13.6±9.3）h,t=2.798,P=0.007]、监护时间[（26.4±15.6）h vs.（51.0±40.0）h,t=3.138,P=0.003]均较OPCAB组显著缩短。Hybrid组PCI时间距手术（6.1±2.6）d,植入支架（2.6±1.9）枚。Hybrid组术后肝酶峰值、血肌酐峰值与OPCAB组均无显著性差异（P〉0.05）。2组患者均无住院期间死亡。术后3个月电话随访,均存活,无再入院,无再发脑梗死、心肌梗死、肾功能衰竭,也无明显心绞痛症状。结论分站式杂交手术处理冠状动脉多支血管病变安全有效,严格执行围手术期抗凝策略下分站式杂交手术能有效减少出血及用血,且不增加围手术期心肌梗死的发生。

Objective To investigate the efficacy of two-staged hybrid technique for the multiple coronary artery revascularization. Methods A total of 30 patients who underwent two-staged hybrid technique surgery because of coronary multivessel lesions in this center from December 2012 to December 2013 were included retrospectively. Another group of 30 patients who underwent conventional off-pump coronary artery bypass（ OPCAB） at the same period were matched 1： 1 by age,operator and preoperative baseline. Differences of the clinical data were compared between the two groups. Results The hybrid group had shorter operation time [（ 124. 8 ± 22. 2） min vs.（ 211. 8 ± 28. 2） min,t = 13. 277,P = 0. 000]and less blood loss [（ 144. 5 ± 117. 1） ml vs.（ 480. 0 ± 261. 3） ml,t = 6. 418,P = 0. 000]as compared with the OPCAB group. And the blood and serum transfusion volume was significantly less in the hybrid group than that in the OPCAB group（ P〈0. 05）. The hybrid group had significantly shorter length of mechanical ventilation [（ 8. 3 ± 4. 6） h vs.（ 13. 6 ± 9. 3） h,t = 2. 798,P = 0. 007] and ICU stay [（ 26. 4 ± 15. 6） h vs.（ 51. 0 ±40. 0） h,t = 3. 138,P = 0. 003] than those in the OPCAB group. There was no difference between two groups in the postoperative peak of ALT,TNI and serum creatinine（ P〈0. 05）. There were no death during hospitalization in both groups. According to the telephone follow-up for 3 months after surgery,there was no death,readmission,cerebral infarction,myocardial infarction,renal failure,or angina in both groups. Conclusions The two-staged hybrid procedure is safe and feasible for multiple coronary artery revascularization. With intensive anticoagulation and antithrombotic treatment,the hybrid procedure bears reduced perioperative bleeding,low risk of perioperative myocardial infarction,and short time of hospitalization.