摘要
目的:探讨梅毒血清学阳性患者行非体外循环冠状动脉旁路移植术(OPCABG)围手术期安全性,为临床治疗提供参考。方法:回顾性研究2019年1月至2022年12月南京医科大学第一附属医院心脏大血管外科接受OPCABG治疗的868例冠状动脉粥样硬化性心脏病(冠心病)患者,依据术前梅毒螺旋体明胶颗粒凝集试验(TPPA)结果分为阳性组20例和阴性组848例,利用倾向性评分1∶1的比例进行匹配,筛选出观察组和对照组各20例,比较2组患者梅毒感染相关心血管指标,术中移植血管数、手术时间、术后机械通气及重症监护室(ICU)治疗时间、术后并发症发生率及死亡率,并进行统计学分析。结果:观察组和对照组患者梅毒感染相关心血管指标如主动脉瓣反流比例(20%对15%)、升主动脉直径[(30.2±2.2)mm对(30.0±3.1)mm]、冠状动脉开口狭窄比例(5%对0%)差异均无统计学意义(P均>0.05)。观察组和对照组手术相关指标如移植血管数[(3.9±0.8)支对(3.4±0.8)支]、手术时间[(259.8±52.3)min对(257.0±49.4)min]、术后机械通气时间[(37.8±25.0)h对(33.0±12.8)h]、ICU治疗时间[(3.7±2.1)d对(3.8±2.1)d]差异均无统计学意义(P均>0.05)。2组患者术后输血、肺部感染、恶性心律失常、透析治疗、主动脉球囊反搏(IABP)治疗发生率及围手术期死亡率差异均无统计学意义(P均>0.05)。结论:TPPA阳性的冠心病患者可安全施行OPCABG,对此类患者明确诊断和个体化治疗可以降低外科医生感染梅毒风险。
Objective:To investigate the perioperative safety of off-pump coronary artery bypass grafting(OPCABG)in syphilis seropositive patients.Methods:A retrospective study was conducted to select 868 patients who received OPCAB treatment in the Department of Cardiovascular Surgery of the First Affiliated Hospital of Nanjing Medical University from January 2019 to December 2022.According to the results of preoperative treponema pallidum gelatin particle agglutination test(TPPA),they were divided into a research group(20 cases)and a control group(848 cases).The proportion of propensity score 1:1 was used to match,forming 20 cases in the research group and 20 cases in the control group.The cardiovascular indicators related to syphilis infection,the number of grafts,operation time,mechanical ventilation time,length of intensive care unit(ICU)stay,postoperative complication rate and mortality were compared between the two groups,and statistical analysis was conducted.Results:The differences of cardiovascular indicators related to syphilis infection in the observation group and the control group were not statistically significant(all P>0.05),such as the proportion of aortic valve regurgitation(20%vs.15%),the diameter of the ascending aorta(30.2±2.2)mm vs.(30.0±3.1)mm,and the proportion of coronary ostium stenosis(5%vs.0%).Surgery-related indicators in the two groups,such as the number of grafts(3.9±0.8 vs.3.4±0.8),the operation time(259.8±52.3 min vs.257.0±49.4 min),the mechanical ventilation time(37.8±25.0)h vs.(33.0±12.8)h,and the length of ICU stay(3.7±2.1)d vs.(3.8±2.1)d showed no statistical difference(all P>0.05).There were no statistically significant differences between the groups in complications such as the incidence rates of postoperative blood transfusion,pulmonary infection,malignant arrhythmia,dialysis,intra-aortic balloon pump(IABP)therapy and perioperative mortality(all P>0.05).Conclusion:OPCABG can be safely performed on TPPA positive coronary heart disease patients,and definitive diagnosis and indi
作者
黄荷
张瑞丽
王晓伟
刘欢
HUANG He;ZHANG Ruili;WANG Xiaowei;LIU Huan(Department of Dermatology,The Second Affiliated Hospital with Nanjing Medical University,Nanjing 210003;Department of Cardiovascular Surgery,The First Affiliated Hospital with Nanjing Medical University,Nanjing 210029,China)
出处
《国际心血管病杂志》
2024年第3期186-189,共4页
International Journal of Cardiovascular Disease
基金
江苏省卫生健康委重点项目(ZDA2020004)。
关键词
冠状动脉旁路移植术
体外循环
梅毒
Coronary artery bypass graft
Extracorporeal circulation
Syphilis