非体外循环冠状动脉旁路移植术在高危老年患者中的应用

Use of off-pump coronary artery bypass grafting in high-risk elderly patients

目的:评价非体外循环冠状动脉旁路移植术(OPCAB)应用于高危老年冠心病患者的可行性、安全性和优势。方法:选取2013年2月至2017年10月在郑州大学人民医院接受单纯冠状动脉旁路移植术(CABG)治疗的560名高危老年冠心病患者,按手术方式分为OPCAB(A组)和常规体外循环CABG(CCABG,B组),比较两组患者的术前资料(年龄、性别、既往病史、Euro SCORE值等)和临床资料(搭桥数目、术后严重并发症、输血等)。结果:A组年龄偏大(P=0.005)、SCr偏高(P=0.004)、EF值偏低(P=0.013),余术前资料差异无统计学意义(P均>0.05);两组IABP置入率、围术期红细胞输注量、呼吸机使用时间、急性心肌梗死(AMI)、低心排综合征、急性肺损伤/急性呼吸窘迫综合征(ALI/ARDS)、新发急性肾功能不全(ARI)、新发房颤、多器官损伤、院内死亡率等比较,差异有统计学意义(P均<0.001),B组偏高;两组搭桥数目、完全再血管化率、再次手术、神经系统损伤差异无统计学意义(P均>0.05)。结论:OPCAB应用于高危老年冠心病患者,其围术期红细胞输注及术后并发症显著减少,在肾功能、心肺功能保护方面优势明显,是一种安全、可行的手术方式。

Aim： To evaluate the feasibility,safety and advantages of off-pump coronary artery bypass grafting（ OPCAB） in high-risk elderly patients with coronary heart disease. Methods：We selected 560 high-risk elderly patients who accepted coronary artery bypass grafting（ CABG） in People＇s Hospital of Zhengzhou University from February 2013 to October 2017. These patients were divided into two groups,OPCAB（ group A） and conventional CABG（ group B） according to the surgical procedure. The differences of preoperative data（ age,gender,past medical history,Euro SCORE values,etc.）and clinical data（ number of bypass grafts,major postoperative complications,blood transfusions,etc.） between group A and Group B were analyzed. Results：The patients in group A was older（ P = 0. 005）,SCr was higher（ P = 0. 004）,EF was lower（ P = 0. 013）,and other preoperative data were not statistically different（ all P〈0. 05）; there were differences in IABP insertion rate,perioperative RBC transfusion,ventilator use time,acute myocardial infarction（ AMI）,low cardiac output syndrome,acute lung injury/acute respiratory distress syndrome（ ALI/ARDS）,new-onset acute renal insufficiency（ARI）,new-onset atrial fibrillation,multiple organ damage,and in-hospital mortality,and the data above in group B were significantly higher than those in group A（ all P 0. 001）; there were no statistical differences in the number of bypass grafts,complete revascularization rate,reoperation,or nervous system injury（ all P〈0. 05）. Conclusion： OPCAB significantly reduces perioperative RBC transfusion and postoperative complications in high-risk elderly patients,it has obvious advantages in renal function,heart and lung protection,and is a safe and feasible surgical method.