体外循环和非体外循环下冠状动脉旁路移植术的疗效和预后比较

Comparison of curative effects and prognosis between coronary artery bypass grafting with and without cardiopulmonary bypass

目的探讨体外循环和非体外循环下冠状动脉旁路移植术的疗效和预后差异。方法回顾性分析2013年10月至2017年10月期间在西安交通大学第一附属医院实施非体外循环下不停跳冠状动脉旁路移植术的152例患者和体外循环下冠状动脉旁路移植术的107例患者的临床资料,比较两组患者术后恢复情况和主要并发症。结果术后非体外循环组患者ICU治疗时间、心电监测时间、使用抗生素时间、留置引流管时间、呼吸机使用时间、留置动脉测压管时间和术后住院时间均较体外循环组患者减少,且术后引流量明显少于体外循环组患者(P <0. 05)。两组患者术后肾功能不全、主动脉内球囊反搏(IABP)使用、围手术期心肌梗死、二次开胸止血、术后心律失常和术后脑血管意外发生率比较差异无统计学意义(P> 0. 05);而体外循环组患者肺部感染发生率明显高于非体外循环组(P <0. 05)。结论采用非体外循环下不停跳冠状动脉旁路移植术的患者术后肺部感染率明显降低,且术后恢复情况优于体外循环下冠状动脉旁路移植术患者。

Objective To investigate the difference of curative effects and prognosis between coronary artery bypass grafting with and without cardiopulmonary bypass. Methods 152 patients who were operated using off-pump coronary artery bypass grafting (OPCABG) and 107 patients who were performed with on-pump coronary artery bypass grafting (CABG) in the authors' department during the period from October 2013 to October 2017 were included in the study. The differences of postoperative recovery and major complications between the two groups were analyzed. Results Compared with CABG group, patients in OPCABG group had shorter intensive care unit (ICU) monitoring time, electrocardio-monitoring time, duration of antibiotic treatment, time of drainage tube intubation, mechanical ventilation time, arterial piezometer tube monitoring time and length of hospital stay (P<0.05). And postoperative draining fluid volume in patients of OPCABG group was also less than that in CABG group (P<0.05). Additionally, there was no difference between the two groups in postoperative parameters including renal insufficiency, using intra-aortic balloon pump (IABP) machine, perioperative myocardial infarction, second operation for hemorrhage, the occurrence of postoperative arrhythmias and cerebrovascular accident (P>0.05). However, the incidence of postoperative pulmonary infection was significantly higher in patients of CABG group than that in OPCABG group (P<0.05). Conclusions The incidence of postoperative pulmonary infection was significantly decreased in OPCABG group compared with that in CABG group. And the postoperative recovery of patients undergoing off-pump coronary artery bypass grafting was superior to that of patients undergoing on-pump coronary artery bypass grafting.