高龄患者体外循环与非体外循环下CABG围手术期疗效与安全性对比研究

Comparison of perioperative efficacy and safety between on-pump and off-pump coronary artery bypass grafting in elderly patients

目的通过倾向性评分匹配对比研究评价高龄患者体外循环与非体外循环下行冠状动脉旁路移植术(coronary artery bypass grafting,CABG)治疗的效果。方法纳入2014年6月至2019年6月在我科行冠状动脉旁路移植术且年龄大于70岁的患者301例,其中非体外循环下冠状动脉旁路移植术(OPCABG)51例[男性44例,女性7例,年龄70~83(73.31±2.73)岁],利用倾向性评分匹配法从体外循环下冠状动脉旁路移植术(ONCABG)的250例中选出51例[男性46例,女性5例,年龄70~78(72.82±1.86)岁]作为对照组,对比两组患者术后恢复情况。结果与ONCABG组相比,OPCABG组手术死亡率[1例(1.96%)vs 2例(3.92%),P=0.558]、主动脉球囊反搏使用比例[9例(17.64%)vs 13例(25.49%),P=0.336]无统计学差异,气管插管时间[(10.64±5.07)h vs(15.07±5.35)h,P=0.000]、术后当日引流量[(307.15±132.16)mL vs(480.78±130.42)mL,P=0.000]、肾脏替代治疗比例[2例(3.92%)vs 8例(15.69%),P=0.046]显著低于ONCABG。结论对于高龄冠心病患者,两种手术方式均效果满意,与ONCABG相比,OPCABG在加速患者恢复、减少术后并发症等方面更有优势。

Objective To compare the efficiency between on-and off-pump coronary artery bypass grafting(CABG)in elderly patients by propensity score matching(PSM).Methods From June 2014 to June 2019,a total of 301 patients(older than 70 years)undergoing CABG in our department were recruited in this study.For 51 patients underwent off-pump CABG(OPCABG),they were 44 males and 7 females,at an age of 70 to 83(73.31±2.73)years.Another 51 patients including 46 males and 5 females,aged 70-78(72.82±1.86)years,were selected from the remaining 250 patients treated with on-pump CABG(ONCABG)by PSM.Postoperative recovery was analyzed and compared between the 2 groups.Results There were no statistical differences in the mortality[1.96%(1/51)vs 3.92%(2/51),P=0.558]and cases needing intra-aortic balloon pump[IABP,17.64%(9/51)vs 25.49%(13/51),P=0.336]between the OPCABG and the ONCABG groups.But the former group had shorter endotracheal intubation(10.64±5.07 vs 15.07±5.35 h,P=0.000),less drainage volume at the day after surgery(307.15±132.16 vs 480.78±130.42 mL,P=0.000),and lower percentage of the patients needing continuous renal replacement therapy[CRRT,3.92%(2/51)vs 15.69%(8/51),P=0.046]when compared with the ONCABG group.Conclusion Both OPCABG and the ONCABG surgeries are effective treatment for the elderly patients with coronary heart disease.However,OPCABG is superior to ONCABG in accelerating postoperative recovery and reducing postoperative complications.