两种介入手术方案对多支病变冠心病患者围术期临床指标、生存率及术后并发症发生率的影响

Effects of two kinds of interventional operation scheme on perioperative clinical indicators, survival rate and postoperative complications incidence of patients with multivessel coronary artery disease

目的探讨非体外循环冠状动脉旁路移植术与一站式复合冠状动脉血运重建术对多支病变冠状动脉粥样硬化性心脏病(冠心病)患者围术期临床指标、生存率及术后并发症发生率的影响。方法研究对象选取青岛阜外心血管病医院2007年3月至2011年7月收治的多支病变冠心病患者共110例,其中,行非体外循环冠状动脉旁路移植术共82例设为对照组,行一站式复合冠状动脉血运重建术共28例设为观察组。比较两组围术期临床指标、随访3年生存率及术后并发症发生率等。结果观察组术中输血率、呼吸机辅助时间、术后胸腔积液量、重症监护病房停留时间及住院时间均显著优于对照组,差异有统计学意义(P<0.05)。两组随访期间生存率比较,差异无统计学意义(P>0.05)。两组术后并发症发生率比较,差异无统计学意义(P>0.05)。结论非体外循环冠状动脉旁路移植术与一站式复合冠状动脉血运重建术对多支病变冠心病具有接近的临床疗效及安全性;同时,一站式复合冠状动脉血运重建术可有效减少术中创伤,缩短呼吸机使用时间,并有助于加快病情康复进程。

Objective To investigate the effects of two kinds of interventional operation scheme including off-pump coronary artery bypass graftine （CABG） and one-step hybrid coronary revascularization on perioperative clinical indicators, survival rate and postoperative complications incidence of patients with multivessel coronary artery disease. Methods Totally 110 patients with muhivessel coronary artery disease from March 2007 to July 2011 in Qingdao Fuwai Cardiovascular Hospital were chosen and divided into two groups, including control group （82 cases） with offpump CABG and observation group （28 cases） with one-step hybrid coronary revascularization. Levels of perioperative clinical indicators, survival rates in 3 years with follow-up and postoperative complication incidences of both groups were compared. Results Blood transfusion rate during operation and postoperative pleural effusion volume of observation grooup were significanly lower than those of control group （P〈0.05）. And ventilation time, intensive-care-unit- staying-duration and inhospital-staying-duration of obsevation group were significantly shorter than those of control group （P〈0.05）. There was no significant difference in the survival rate during follow-up between the 2 groups （P〉 0.05）. There was no significant difference in postoperative complication incidence between the 2 groups （P〈0.05）. Conclusions Off-pump CABG and one-step hybrid coronary revascularization in treatment of patients with muhivessel coronary artery disease possess the same clinical effects and safety; but one-step hybrid coronary revascularization application can effectively reduce the trauma degree during operation, shorten the time of respirator being used and be helpful to shorten the rehabilitation process.