体外与非体外冠状动脉旁路移植术早期临床结果的比较

On-Pump Versus Off-Pump Coronary Artery Bypass Surgery: A Comparison Study of Early Clinical Outcomes

【目的】研究体外冠状动脉旁路移植术(on-pumpcoronaryarterybypassgrafting,oron-pumpCABG)与非体外冠状动脉旁路移植术(off-pumpcoronaryarterybypassgrafting,oroff-pumpCABG)的早期临床效果,论证off-pumpCABG优于on-pumpCABG。【方法】从2000年1月至2001年12月,连续215例病人进行冠状动脉旁路移植术,病人分成两组,A组为体外循环组(109例),B组为非体外循环组(106例)。记录术前、术中和术后各有关参数,并对两组数据作统计学比较分析。【结果】除非体外循环组(B组)合并心肌梗死和周围血管病所占比例较高外(A组比B组分别为23.9%比39.6%和0.9%比8.5%,P<0.05),两组病人组成无显著性差异。A组移植血管数量略高于B组犤(2.8±0.8)支vs(2.6±1.0)支,P>0.05犦,但乳内动脉应用率明显少于B组(60.1%vs92.5%,P<0.05)。B组有2例转为体外循环搭桥,其发生率为1.9%。A组和B组的手术死亡率分别为3.7%和2.8%(P>0.05)。A组术后低心排和需主动脉内气囊泵(intra-arteryballoonpump,IABP)支持的病人高于B组,分别为38.5%比7.5%和19.3%比4.7%,P<0.05。两组脑血管事件发生率分别为8.3%和0.9%(P<0.05)。平均辅助呼吸时间分别为犤(55.8±11.6)h和(30.8±16.2)h(P<0.05),平均住重症监护室(ICU)时间分别为犤(7.23±3.2)d和(2.85±1.

Objective] To demonstrate that off pump coronary artery bypass grafting(off pump CABG) is superior to on pump coronary artery bypass grafting (on pump CABG). The early clinical outcomes of on pump CABG and off pump CABG were studied. From January 2000 to December 2001, 215 cases underwent CABG. They were divided into two groups: 109 on pump CABG cases (Group A) and 106 off pump CABG cases (Group B). The data of preoperation, intra operation and postoperation were collected and was statistically analysized. The myocardial infarction and peripheral vessel disease in Group B were 39.6% and 8.5% respectively, much higher than that in Group A (23.9% and 0.9% , P< 0.05). No significant differences in other demographic data were found between the two groups. The average grafts per patient was 2.8± 0.8 in Group A and 2.6 ± 1.0 in Group B(P >0.05), but the internal mammary artery used was 60.1% in Group A, much less than in Group B (92.5% ,P< 0.05). Operative mortality (died within 30 days) was 3.7% in Group A and 2.8% in Group B (P >0.05). The percentage of low cardiac output and IABP used in Group A was 38.5% and 19.3% respectively, much higher than that in Group B (7.5% and 4.1% , P< 0.05). Stroke was 8.3% in Group A and 0.9% in Group B (P< 0.05). The mean time of mechanical ventilation was (55.8± 11.6) h in Group A and (30.8± 16.2) h in Group B (P< 0.05). The mean period of stay in ICU was (7.23± 3.2) days in Group A and (2.85± 1.8) days in Group B. [ Conclusion] Off pump CABG is safe and effective. It can reduce the risk of severe complications of CABG. The early clinical outcomes are superior to that of on pump CABG.