间断小切口获取大隐静脉作为桥血管应用于冠状动脉旁路移植术的临床效果研究

Clinical effect of coronary artery bypass grafting with great saphenous vein obtained through intermittent small incision as a bridge vessel

目的探讨间断小切口获取大隐静脉作为桥血管应用于冠状动脉旁路移植术(CABG)的临床效果。方法选取2016年9月至2018年4月在陕西省人民医院心血管外科接受全身麻醉体外循环下CABG,以大隐静脉作为桥血管的患者,其中74例采用间断皮肤小切口获取大隐静脉作为观察组,选取同期52例采用传统全程切开皮肤获取大隐静脉作为对照组。比较2组患者大隐静脉修补点数、冠状动脉和大隐静脉桥吻合口数、大隐静脉桥长度、下肢切口长度、大隐静脉桥获取时间、下肢切口关闭时间、下肢操作总时间、术后下肢切口评价指标、术后第2天下床活动比例和术后1~3年大隐静脉桥血管吻合口通畅率。结果2组患者大隐静脉修补点数、冠状动脉和大隐静脉桥吻合口数、大隐静脉桥长度、下肢操作总时间比较,差异均无统计学意义(均P>0.05)。观察组下肢切口长度和下肢切口关闭时间短于对照组[(15.4±2.6)cm比(43.4±7.0)cm、(7.7±1.3)min比(27.0±4.6)min],而大隐静脉桥获取时间长于对照组[(45.3±9.9)min比(27.4±5.4)min],差异均有统计学意义(均P<0.01)。观察组患者术后下肢切口疼痛评分、麻木比例低于对照组[(3.1±1.5)分比(3.8±1.5)分、27.0%(20/74)比57.7%(30/52)],差异均有统计学意义(均P<0.01),2组患者术后下肢切口发生肿胀、皮下淤血、需要二期清创比例差异均无统计学意义(均P>0.05)。观察组术后第2天下床活动比例高于对照组,差异有统计学意义(P=0.03)。2组术后1~3年大隐静脉桥血管吻合口通畅率比较差异无统计学意义(P=0.96)。结论间断小切口获取大隐静脉作为桥血管应用于CABG操作方便,不增加大隐静脉损伤,有利于患者术后康复,且大隐静脉桥血管中远期通畅率满意。

Objective To investigate the clinical effect of coronary artery bypass grafting(CABG)using the great saphenous vein obtained through intermittent small incision as a bridge vessel.Methods From September 2016 to April 2018,patients who received CABG with the great saphenous vein as the bridge vessel under general anesthesia and cardiopulmonary bypass in the Department of Cardiac Surgery,Shaanxi Provincial People′s Hospital were selected,which 74 cases were obtained through intermittent small incision as the observation group,and 52 cases through traditional incision were collected as the control group in the same period.The number of repair points of great saphenous vein,the number of anastomoses of coronary artery and great saphenous vein bridge,the length of great saphenous vein bridge,the length of incision of lower limbs,the acquisition time of great saphenous vein bridge,the closing time of incision of lower limbs,the total time of operation of lower limbs,the evaluation index of incision of lower limbs after operation,the proportion of out of bed activity on the second day after operation and the patency rate of anastomoses of great saphenous vein bridge in 1-3 years after operation were compared between the two groups.Results There were no significant differences between the two groups in the number of great saphenous vein repairs,the number of anastomoses of coronary artery and great saphenous vein bridge,the length of great saphenous vein bridge,and the total operation time of lower limbs(all P>0.05).The length of lower limb incision and the closing time of lower limb incision in the observation group were less than those in the control group[(15.4±2.6)cm vs(43.4±7.0)cm,(7.7±1.3)min vs(27.0±4.6)min],while the acquisition time of saphenous vein bridge was longer than that in the control group[(45.3±9.9)min vs(27.4±5.4)min](all P<0.01).The pain score and numbness ratio of lower limb incision after operation in the observation group were lower than those in the control group[(3.1±1.5)vs(3.8±1.5),27.0%(20/74)vs 57.7%(30/52)](both P<0.01).There were no statistically significant differences between the two groups in the proportions of lower limb incision swelling,subcutaneous blood stasis,and the need for secondary debridement(all P>0.05).The proportion of out of bed activity in the observation group was higher than that in the control group on the second day after operation(P=0.03).There was no significant difference in the patency rate of great saphenous vein bridge anastomosis between the two groups 1-3 years after operation(P=0.96).Conclusion Intermittent small incision to obtain the great saphenous vein as a bridge vessel for CABG is convenient to operate,does not increase the injury of the great saphenous vein,is conducive to the postoperative rehabilitation of patients,and the medium and long term patency rate of the great saphenous vein bridge vessel is satisfactory.