微创冠状动脉旁路移植术患者239例临床疗效的倾向性评分匹配研究

Clinical outcomes of minimally invasive coronary artery bypass grafting in 239 patients:A propensity score matching study

目的对比微创冠状动脉旁路移植术(minimally invasive coronary artery bypass grafting,MICS CABG)和常规冠状动脉旁路移植术(coronary artery bypass grafting,CABG)围术期临床疗效及中期随访结果。方法收集2017年1月—2021年10月北京安贞医院单一医疗中心行不停跳CABG患者。按照手术方式将患者分为微创组(MICS CABG由单一术者完成)和常规组(正中开胸)。对两组术前资料进行倾向性评分匹配,比较两组患者围术期资料及术后随访数据。结果共纳入890例患者。微创组239例,其中男211例、女28例,年龄(60.54±9.40)岁;常规组651例,其中男487例、女164例,年龄(62.31±8.64)岁。倾向性评分匹配后两组各239例。与常规组相比,微创组患者平均手术时间长、引流时间短、术后第1 d引流量少、术后住院时间短、正性肌力药物使用率低,而两组平均桥血管数量、住ICU时间、呼吸机辅助时间、输血率以及围术期并发症发生率差异无统计学意义(P>0.05)。中位随访2.25年,随访数据显示两组患者主要心脑血管不良事件(全因性死亡、脑卒中、再次血运重建)发生率差异无统计学意义(P>0.05)。结论通过合适的病例指征把控,MICS CABG可达到不差于常规CABG的围术期及中期手术效果,并在术后住院时间、术后引流量、术后正性肌力药物使用率方面优于常规CABG。

Objective To investigate the perioperative clinical effects and follow-up results of minimally invasive coronary artery bypass grafting(MICS CABG)versus conventional coronary artery bypass grafting(CABG)in thoracotomy.Methods The patients who received off-pump CABG in Beijing Anzhen Hospital from January 2017 to October 2021 were collected.Among them,the patients receiving MICS CABG performed by the same surgeon were divided into a minimally invasive group,and the patients receiving median thoracotomy were into a conventional group.By propensity score matching,preoperative data were balanced.Perioperative and postoperative follow-up data of the two groups were compared.Results A total of 890 patients were collected.There were 211 males and 28 females,aged 60.54±9.40 years in the minimally invasive group,and 487 males and 164 females,aged 62.31±8.64 years in the conventional group.After propensity score matching,there were 239 patients in each group.Compared with the conventional group,patients in the minimally invasive group had longer operation time,shorter drainage duration,less drainage volume on the first postoperative day,shorter postoperative hospital stay,and lower rate of positive inotropenic drugs use,while there was no statistical difference in the mean number of bypass grafts,ICU stay,ventilator-assisted time,blood transfusion rate or perioperative complications(P>0.05).During the median follow-up of 2.25 years,there was no statistical difference in major adverse cardiovascular and cerebrovascular events,including all-cause death,stroke or revascularization between the two groups(P>0.05).Conclusion Reasonable clinical strategies can ensure perioperative and mid-term surgical outcomes of MICS CABG not inferior to conventional CABG.In addition,MICS CABG has the advantages in terms of postoperative hospital stay,postoperative drainage volume,and rate of positive inotropic drugs use.