常规与非体外循环下冠状动脉3支病变旁路移植血管通畅性对比分析

Comparative study on graft patency between off-pump and conventional coronary artery bypass grafting in the treatment of triple vessel coronary disease

目的 评价非体外循环下冠状动脉旁路移植术 (OPCAB)与体外循环下冠状动脉旁路移植术 (CCABG)治疗冠状动脉三支病变术中旁路早期通畅性。方法 6 0例 3支血管病变的病人分为OPCAB组和CCABG组 ,每组各 30例。行冠状动脉旁路移植术 ,OPCAB组胸骨正中切口 ,在非体外循环心脏不停跳下完成手术 ;CCABG组建立常规体外循环 ,心脏停跳下完成手术。术中应用即时血流测量技术对旁路血管进行流量测量。对比分析两组术前、术后的各项指标及各血管旁路流量、搏动指数和血流波形。结果 两组病人术前一般情况差异无统计学意义。OPCAB组与CCABG组移植旁路血管分别为 (3 6±0 6 )支与 (4 3± 0 9)支 (P <0 0 1) ;两组前降支及右冠状动脉旁路血流量、搏动指数差异无显著性。CCABG组回旋支序贯旁路和远端吻合口多 ,血流量较OPCAB组高。两组弥漫病变血管旁路血流量小。结论 OPCAB与CCABG治疗 3支病变 ,两组血管旁路早期通畅性差异无显著性。

Objective: To assess graft patency by transit time flow meter (TTFM) technique in off pump (OPCAB) and conventional coronary artery bypass grafting (CCABG) for the treatment of triple vessel coronary disease. Methods: Between June 2000 and April 2001, 60 patients with triple vessel coronary artery disease underwent CABG. They were divided into two groups, OPCAB and CCABG groups. All completed grafts were tested introperatively with TTFM. Preoperative and postoperative variables of two groups were compared. Results: There were no significant difference in sex, age, body weight, history of acute or remote myocardium infarction, hypertension, diabetes and type of bypass grafts between two groups. The number of bypass grafts, the assisted respiratory time in OPCAB group was significant less than that in CCABG group. The flow, PI of the left anterior descending artery bypass grafts and right coronary artery bypass grafts were not significant different between OPCAB and CCABG groups. The flow of OM in CCABG group with sequential grafts was more than that in OPCAB group. With diffuse narrowed coronary artery, bypass grafts in both groups had lower flow. Conclusion: There were no differences in graft patency in patients with triple vessel coronary artery disease underwent OPCAB and CCABG.