摘要
目的研究在不停跳冠状动脉搭桥中,以常规技术大隐静脉为参照,探讨应用"不接触"技术是否增加围术期风险,及两种方法获取的大隐静脉在显微结构方面的差别。方法 36例行不停跳冠状动脉搭桥的病例被纳入研究,"不接触"组和常规组各18例。观察指标包括术中资料,获取大隐静脉时间、总手术时间等;术后资料,呼吸机应用时间、监护室停留时间、引流量、术后肌钙蛋白等。并对两组大隐静脉进行光镜下显微结构对比。结果 "不接触"组大隐静脉的获取时间较常规组增加,平均[(46.78±9.47)min vs.(33.33±10.35)min],差异有统计学意义(P=0.000)。手术时间、术后引流量、呼吸机应用时间、监护室停留时间、术后住院时间、术后肌钙蛋白Ⅰ两组差异无统计学意义(P>0.05)。两组均未出现下肢感染和死亡。光镜下"不接触"组相比常规组大隐静脉内皮细胞更加饱满完整,平滑肌细胞排列更加规整,滋养血管更丰富。在常规组大隐静脉可发现炎性细胞。结论 "不接触"技术相比常规大隐静脉在围术期不增加手术风险,且"不接触"大隐静脉在显微结构上更有优势。
Objective To evaluate the clinical safety and feasibility of "no-touch" technique compared with conventional technique of harvesting saphenous vein graft (SVG) in coronary artery bypass grafting (CABG)on beating heart,andthe microstructural features were also compared. Methods 36 patients who underwent CABG were enrolled in this study.Patients were equally divided intothe "no-touch" group and the conventional group with (n =10).Intraoperative data as harvesting time of SVGs and total surgery time etc,postoperative data as ventilator application time,intensive care unit stay time,volume of drainage and postoperative troponin,etc.SVGs microstructure of two groups were compared under the light microscope. Results The time of harvesting SVGs in the"no-touch" group was significantly longer than the conventional group [mean time (46.78± 9.47) min vs .(33.33±10.35)min],with significant difference (P = 0.000 ).Operation time,postoperative drainage,ventilator application time,intensive care unit stay time,postoperative hospitalization time and cTNI had no statistical difference (P >0.05).No infection or death occurred in either group.Under the light microscope,compared with conventional SVGs,the endothelium layers of "no-touch" SVGs showed more intact,smooth muscle cells were arranged more regularly,and the vasa vasorum were more abundant.Inflammatory cells could be found in the conventional group. Conclusion Compared to conventional technique,"no-touch" technique did not increase the perioperative risks.Moreover,"no-touch " SVGs showed advantages in microstructure.
作者
季元璋
赵博
郑宝石
JI Yuanzhang;ZHAO Bo;ZHENG Baoshi(Institute of Cardiovascular Diseases,the First Affiliated Hospital of Guangxi Medical University,Nanning,Guangxi 530000,China;Department of Cardiovascular Surgery,Nanyang Second People′s Hospital,Nanyang,Henan 473000,China)
出处
《重庆医学》
CAS
2019年第18期3107-3110,共4页
Chongqing medicine
基金
广西自然科学基金项目(2016GXNSFAA380309)
关键词
冠脉搭桥术
大隐静脉
不接触技术
coronary artery bypass grafting
saphenous vein graft
no-touch technique
