单中心体外和非体外循环下冠状动脉旁路移植术后远期临床效果研究

Long-term clinical outcomes of single center patients undergoing on-pump or off-pump coronary artery bypass grafting

目的:对比研究体外和非体外循环下冠状动脉旁路移植(CABG)术后的长期临床效果以及影响长期预后的危险因素。方法:回顾性分析2005年1月至2005年12月,在北京安贞医院单纯行CABG术顺利出院751例患者的临床资料,对其进行随访,所有病例随访截止时间为2018年7月,随访结果为生存时间(月)、死亡事件、再次心肌血运重建(经皮冠状动脉介入治疗和CABG术)、前降支通畅率,用倾向得分匹配(1∶1)和生存分析的方法评估患者的临床效果差异。结果:随访时间为150～162个月,随访期内死亡176例(23.4%),其中与心脏相关死亡125例(16.6%)。体外循环(OPCABG)组和非体外循环(ONCABG)组术后10年、13年生存率分别为71.4%vs. 78.1%、69.6%vs. 75.0%,两组生存率差异无统计学意义(P>0.05)。COX回归分析表明,年龄(RR=0.544,P=0.00)、吸烟(RR=6.678,P=0.00)、糖尿病(RR=2.937,P=0.00)、EuroSCORE>3(RR=2.245,P=0.035)。OPCABG和ONCABG的前降支通畅率为87.6%和90.4%(P>0.05)。结论:OPCABG和ONCABG对冠心病患者治疗的远期效果无明显差异,高龄(>60岁)、吸烟、糖尿病、EuroSCORE评分>3分(中高危)是影响患者长期预后的独立危险因素,而体外循环的运用并不影响患者的长期临床效果。

Objective:To investigate the long-term survival rate and risk factors of coronary disease patients undergoing on-pump or off-pump coronary artery bypass grafting(CABG).Methods:We retrospectively analyzed clinical records of discharged patients undergoing CABG on Beijing AnZhen Hospital in January 2005 to December 2005.The follow-up outcomes are comprised of survival time(month),death,repeat revascularization(CABG or percutaneous coronary intervention),anterior descending branch patency rate,and then,we analyzed the data with the method of propensity score matching(PSM)and survival analysis by SPSS 24.0 and STATA 11.0.Results:The follow-up time are 150~162 months.During the follow-up period,176 patients(23.4%)died,including 125 patients(16.6%)of cardiac related deaths.The 10-year and 13-year survival rates of OPCABG and ONCABG were 71.4%vs.78.1%and 69.6%vs.75.0%,respectively.Single factor log-rank test P >0.05 showed no statistically significant difference in survival rate between the two groups.COX regression analysis showed that age(RR=0.544,P=0.00),smoking(RR=6.678,P=0.00),diabetes(RR=2.937,P=0.00),EuroSCORE >3(RR=2.245,P=0.035).The anterior descending branch patency rate of OPCABG and ONCABG was 87.6%and 90.4%(P >0.05).Conclusions:There was no significant difference between OPCABG and ONCABG in the long-term clinical outcomes of coronary heart disease,and Age( >60 years old),smoking,diabetes,and EuroSCORE >3 points(middle and high risk)rather than the use of cardiopulmonary bypass are independent risk factors influencing patients'long-term prognosis.