体外循环下冠状动脉旁路移植术主动脉阻断方式与术后卒中的关系

Relationship between aortic clamp ways and postoperative stroke in patients undergone on-pump coronary artery bypass grafting

目的比较单纯冠状动脉旁路移植术(CABG)中完全主动脉阻断(TAC)与部分主动脉阻断(PAC)两种主动脉阻断方式的术后30 d卒中发生率及死亡率。方法纳入2014年1月至2015年7月间469例于阜外医院行体外循环下单纯CABG的患者,其中TAC组265例,PAC组204例。观察患者术后30天卒中发生率及死亡率。检索并筛选了12项同类研究进行Meta分析。结果TAC组血管吻合口数目较多[(3.29±0.74)个vs.(2.97±0.974)个,P<0.001)。TAC组体外循环时间短于PAC组[(93.2±22.4)min vs.(103.4±26.8)min,P<0.001),术后30 d内死亡率相似(0.4%vs.1.0%,P=0.47]。两组患者术后30 d均未发生卒中。Meta分析显示TAC组和PAC组术后30 d内的卒中和死亡情况相似(OR=0.78,95%CI:0.58~1.06;OR=0.82,95%CI:0.61~1.10),亚组Meta分析也有同样的结果。结论TAC和PAC技术对单纯体外循环下行CABG患者术后30 d的卒中和死亡发生率的影响无明显差异,但TAC技术可缩短体外循环应用时间。

Objective To compare the incidence rate of stroke and mortality between total aortic clamp(TAC)and partial aortic clamp(PAC)in coronary artery bypass grafting(CABG)after 30 d.Methods The patients received on-pump CABG(n=469)in Fuwai Hospital were chosen from Jan.2014 to July 2015,and there were 265 cases in TAC group and 204 in PAC group.The incidence rate of stroke and mortality were observed after operation for 30 d,and 12 similar studies were retrieved,screened and given a Meta-analysis.Results The number of anastomotic sites was more in TAC group[(3.29±0.74)vs.(2.97±0.974),P<0.001].The time of cardiopulmonary bypass was shorter in TAC group than that in PAC group[(93.2±22.4)min vs.(103.4±26.8)min,P<0.001],and mortality after operation for 30 d was similar between 2 groups[(0.4%vs.1.0%,P=0.47)].There was no patient attacked by stroke in 2 groups after operation for 30 d.The results of Meta-analysis showed that stroke incidence and mortality were similar in TAC group(OR=0.78,95%CI:0.58~1.06)and PAC group(OR=0.82,95%CI:0.61~1.10)after operation for 30 d.The Meta-analysis in subgroups showed the same results.Conclusion TAC and PAC have no significant difference in stroke incidence and mortality in patients undergone on-pump CABG after operation for 30 d,but TAC can shorten time of cardiopulmonary bypass.