静脉桥序贯和单纯吻合在不停跳冠状动脉旁路移植术中效果的倾向性评分匹配研究

The efficacies of sequential versus simple anastomosis of saphenous vein in off-pump coronary artery bypass grafting: A propensity score matching study

目的比较大隐静脉桥序贯和单纯吻合在不停跳冠状动脉旁路移植术中的近中期结果。方法回顾性纳入2015—2018年因冠状动脉粥样硬化性心脏病在首都医科大学大兴教学医院行不停跳冠状动脉旁路移植术的患者,共完成大隐静脉顺行序贯吻合438例,与同期165例大隐静脉单纯吻合患者的临床资料进行对比,通过倾向性评分匹配后,序贯吻合组与单纯吻合组各纳入130例患者。序贯吻合组患者中男78例、女52例,年龄60(52,68)岁。单纯吻合组患者中男80例、女50例,年龄61(52,70)岁。对两组患者的近中期临床结果进行对比分析。结果两组患者术前资料基本匹配,围手术期资料具有可比性。序贯吻合组与单纯吻合组患者术后死亡率(1.5%vs.1.5%,P=1.000)和并发症发生率(4.6%vs.6.2%,P>0.05)差异无统计学意义。随访时间12~60(28.3±8.9)个月,随访期间两组患者死亡率差异无统计学意义(3.2%vs.4.0%,P=0.796)。序贯吻合组与单纯吻合组平均桥血管流量差异无统计学意义[(30.0±11.8)mL/min vs.(28.0±9.5)mL/min,P=0.597]。序贯吻合组手术时间短于单纯吻合组[(142.5±21.2)min vs.(186.3±27.6)min,P<0.001],序贯吻合组引流量少于单纯吻合组[(204.7±39.6)mL vs.(271.3±48.3)mL,P<0.001],差异均有统计学意义。结论静脉桥序贯吻合技术优于单纯吻合,可减少主动脉吻合口操作,缩短手术时间,减少引流量,近中期临床效果良好。

Objective To evaluate the short-and mid-term outcomes of sequential anastomosis and simple anastomosis of saphenous vein in off-pump coronary artery bypass grafting.Methods The clinical data of 438 patients who underwent sequential anastomosis of saphenous vein and 165 patients who underwent simple anastomosis of saphenous vein from 2015 to 2018 in Daxing Teaching Hospital were retrospectively analyzed.After propensity score matching,130 pairs of patients were included in the sequential anastomosis group[78 males and 52 females,aged 60(52,68)years]and simple anastomosis group[80 males and 50 females,aged 61(52,70)years].The short-and mid-term clinical outcomes were compared.Results The two propensity score-matched groups had similar baseline clinical data.No significant difference was found between sequential anastomosis and simple anastomosis groups in the in-hospital outcomes,including in-hospital death(1.5%vs.1.5%,P=1.000),the incidence of complications(4.6%vs.6.2%,P>0.05),and the mean flow of grafts(30.0±11.8 mL/min vs.28.0±9.5 mL/min,P=0.597).The operation time of the sequential anastomosis group was shorter than that of the simple anastomosis group(142.5±21.2 min vs.186.3±27.6 min,P<0.001).The drainage of the sequential anastomosis group was less than that of the simple anastomosis group(204.7±39.6 mL vs.271.3±48.3 mL,P<0.001).The follow-up time was 12-60(28.3±8.9)months,during which the mortality of the two groups was not statistically different(3.2%vs.4.0%,P=0.796).Conclusion The saphenous vein sequential anastomosis of saphenous vein is superior to the simple anastomosis.Sequential anastomosis technique can reduce aortic anastomosis,shorten operation time,and reduce bleeding drainage during off-pump coronary artery bypass grafting.The short-and mid-term clinical effects are satisfactory.