分站式杂交冠状动脉血运重建术治疗冠状动脉多支病变近中期效果探究

Short-term and Mid-term Efficacy of Staged Hybrid Coronary Revascularization for Multiple Coronary Artery Lesions

目的探究分站式杂交冠状动脉血运重建术(HCR)治疗冠状动脉多支病变的近中期效果。方法选取2019年5月—2021年4月收治的冠状动脉多支病变40例,依据手术方式不同将其分为观察组和对照组2组各20例。观察组采用分站式HCR,对照组采用左胸小切口冠状动脉旁路移植术。比较2组围手术期相关指标、心肌损伤指标、动脉桥即时血流及术后7 d桥血管通畅率、术后1年不良事件发生情况及术后复工或运动情况。结果观察组手术时间及住院时间长于对照组(P<0.05,P<0.01)。术后3 d,血清肌酸激酶同工酶、肌钙蛋白T及丙二醛2组均较术前升高,但观察组低于对照组(P<0.05,P<0.01)。2组动脉桥即时血流值及动脉桥血流量搏动指数比较差异无统计学意义(P>0.05);观察组术后7 d桥血管通畅率高于对照组(P<0.05)。术后1年,观察组不良事件总发生率低于对照组(P<0.05)。术后1个月内,观察组复工或运动人数所占比例高于对照组(P<0.01);术后3~<7个月,观察组复工或运动人数所占比例低于对照组(P<0.05)。结论分站式HCR治疗冠状动脉多支病变患者,可明显改善心肌损伤及动脉血流情况,减少不良事件发生,促使尽早复工或运动,具有较好近中期效果。

Objective To investigate the short-term and mid-term efficacy of staged hybrid coronary revascularization(HCR)for the treatment of multiple coronary artery lesions.Methods A total of 40 patients with multiple coronary artery lesions admitted from May 2019 to April 2021 were selected and divided into observation group(n=20)and control group(n=20)according to different surgical methods.The observation group was treated with staged HCR,while the control group was treated with coronary artery bypass grafting through a small incision in the left chest.Perioperative related indexes,myocardial injury indexes,instantaneous blood flow in arterial bridge,patency rate at 7 d after surgery,occurrence of adverse events at 1 year after surgery and time to return to work or do exercise after surgery were compared between the two groups.Results In the observation group,the duration of operation and length of hospital stay were longer than those in the control group(P<0.05,P<0.01).At 3 d after surgery,the postoperative serum creatine kinase isoenzyme(CK-MB),troponin T(CTnT)and malondialdehyde(MDA)were higher in both groups compared with the preoperative period,but lower in the observation group than in the control group(P<0.05,P<0.01).There was no significant difference between the two groups in the instantaneous blood flow value and blood flow pulsation index in the arterial bridge(P>0.05).At 7 d after surgery,the bridge vessel patency rate was higher in the observation group than in the control group(P<0.05).At 1 year after surgery,the incidence of postoperative adverse events was lower in the observation group than in the control group(P<0.05).The proportion of people who returned to work or did exercise was higher in the observation group than in the control group within 1 month after surgery(P<0.01),but lower in the observation group than in the control group at 3-<7 month after surgery(P<0.05).Conclusion Staged HCR for multiple coronary artery lesions can significantly improve myocardial injury and arterial blood flow in patients,reduce the occurrence of adverse events,and facilitate an early return to exercise and life with a better short-term and mid-term efficacy.