体外循环与非体外循环下冠状动脉旁路移植术疗效的对比研究

Comparative study on the efficacy of coronary artery bypass grafting under cardiac-pulmonary bypass and non-cardiac-pulmonary bypass

目的 :对比研究 76例非体外循环冠状动脉旁路移植术 (OPCAB)和 82例常规体外循环下冠状动脉旁路移植术 (CCABG)的疗效。方法 :回顾性分析 2 0 0 0年 12月～ 2 0 0 2年 1月间 15 8例冠状动脉旁路移植手术的治疗结果 ,将 15 8例分为OPCAB和CCABG两组。OPCAB组采用胸骨正中切口 ,在非体外循环下完成旁路移植 ;CCABG组常规建立体外循环 ,在心脏停跳下完成旁路移植。结果 :两组间性别、年龄、陈旧性心肌梗死病史、心功能分级、不稳定型心绞痛 ,并发糖尿病、高血压和高脂血症 ,平均每例冠状动脉病变OPCAB组 2 .2支 /例 ,CCABG组 3.6支 /例等无统计学差异 ,但平均每例旁路移植数分别为 2 .1与 3.4支 (P <0 .0 5 )。两组均无手术死亡 ,术后OPCAB组无死亡 ,CCABG组死亡 4例。神经精神并发症OPCAB组 2 .6 % (2 /76 )、CCABG组 6 .1% (5 /82 ) (P <0 .0 5 ) ;术后随访 1～ 13个月 ,OPCAB组 3例复发心绞痛 (4.0 % ) ,CCABG组 4例复发心绞痛 (4.9% ) ,两组随访期间均无死亡。结论 :OPCAB安全可行 ,疗效确实 ,与CCABG相比 ,有一定优势 ,但不能取代CCABG。

Objective:To evaluate clinic efficacy of off pump coronary artery bypass grafting (OPCABs) and conventional CABGs(CCABG).Methods:Retrospectively analysed the operative results of 158 cases of CABGs.Results:There were no significant differences in clinic characteristic between 2 groups. The average bypass grafts for every patient were 2.1 ± 0.6 in OPCAB group and 3.4 ± 0.9 in CCABG group(P< 0.05 ). There were no operative death. Four case of postoperative deaths occurred in CCABG group. The rate of nerve psychiatric complications occurred was 2.6 % in OPCAB and 6.1 % CCABG group(P< 0.05 ). The results of 1 13 month follow up showed that recurrent rate of angina pectoris was 4.0 % in OPCAB and 4.9 % in CCABG. There were no follow up death.Conclusion:OPCAB procedure is a practicable, safe alternative to conventional CABG. Compared with CCABG, OPCAB shows some advantages, but cannot replace CCABG.