摘要
目的比较再次冠状动脉旁路移植术(Re-CABG)中采用体外循环心肺转流(ONCABG)或非体外循环心脏不停跳(OPCABG)术式的围术期及远期预后。方法回顾性分析首都医科大学附属北京安贞医院2006年1月至2017年3月收治的既往有经皮冠状动脉介入(PCI)史且距首次冠状动脉旁路移植术(CABG)时间间隔在6个月以上的行Re-CABG的患者,术后1年内共随访到56例,所有患者因Re-CABG术式不同分为OPCABG组(29例)和ONCABG组(27例)。记录性别、年龄、两次CABG时间间隔、PCI距Re-CABG时间、桥血管PCI史、高血压病史、糖尿病病史、吸烟、Euro Score评分内容,观察移植物个数、围术期是否使用主动脉内球囊反搏(IABP)/体外膜肺氧合(ECMO)/连续肾脏替代治疗(CRRT)等辅助治疗,记录围术期和术后1年病死率。结果ONCABG组Euro Score评分小于OPCABG组[(6.5±1.6)分比(8.4±1.1)分],差异有统计学意义(P<0.001),主要原因是ONCABG组心脏和主动脉手术比例明显多于OPCABG组[37.0%(10/27)比0](P=0.001)。ONCABG组的移植物数量有多于OPCABG组的趋势(P=0.079),2组围术期IABP/ECMO/CRRT等器械辅助治疗比例、围术期和术后1年病死率差异均无统计学意义(均P>0.05)。结论在既往有PCI史的患者,Re-CABG术中无论使用OPCABG或是ONCABG术式,围术期和远期预后相当;高风险患者目前一般使用ONCABG术式。
Objective To compare the perioperative and long-term safety of on-pump coronary artery bypass grafting(ONCABG)and off-pump coronary artery bypass grafting(OPCABG)in redo coronary artery bypass grafting(Re-CABG)surgery.Methods A Retrospective analysis was made in the patients who underwent Re-CABG with history of percutaneous coronary intervention(PCI)in Beijing Anzhen Hospital,Capital Medical University from January 2006 to March 2017.A total of 56 cases were followed up for 1 year after operation.All patients were divided into OPCABG group(29 cases)and ONCABG group(27 cases).Age,gender,first CABG to Re-CABG time,PCI to Re-CABG time,bridge vessel PCI history,hypertension,diabetes,smoking history and Euro Score were recorded.The number of grafts and intra-aortic balloon pump(IABP)/extracorporeal membrane lung(ECMO)/continuous renal replacement therapy(CRRT)were observed.The mortalities during the perioperative period and 1 year after operation were recorded.Results The Euro Score score of ONCABG group was significantly lower than that of OPCABG group[(6.5±1.6)vs(8.4±1.1)](P<0.001).Cardiovascular operations in ONCABG group was significantly more than that in OPCABG group[37.0%(10/27)vs 0](P=0.001).The number of grafts in ONCABG group was larger than in OPCABG group(P=0.079).There was no significant difference in perioperative IABP/ECMO/CRRT,perioperative and 1-year mortality between the two groups(all P>0.05).Conclusions In patients with previous history of PCI,the perioperative and long-term effects of OPCABG and ONCABG in Re-CABG surgery are equivalent.ONCABG is commonly used in high-risk patients.
作者
程宇彤
左鑫伟
孙涛
王苏
阴赪茜
陶英
张京梅
李志忠
Cheng Yutong;Zuo Xinwei;Sun Tao;Wang Su;Yin Chengqian;Tao Ying;Zhang Jingmei;Li Zhizhong(The I5th Ward,Department of Cardiology,Bejing Anzhen Hospital,Capital Medical University,Bejing 100029,China;Department of Internal Medicine,Wu'an Chinese Medicine Hospital,Hebei Prorince,Wu'an 056300,China)
出处
《中国医药》
2020年第6期839-842,共4页
China Medicine
基金
西藏自治区自然科学基金(XZ2017ZR-ZYZ47).
