糖尿病病人行OPCAB与CCABG的早期结果对比  

Comparison of OPCAB and CCBG in patients with diabetes mellitus

作　　者：肖苍松[1] 高长青[1] 吴扬[1] 李伯君[1] 王刚[1] 姜胜利[1] 杨明[1] 叶卫华[1] 刘国鹏[1] 骊晓辉[1] 李佳春[1] 王加利[1] 张涛[1] 

机构地区：[1]解放军总医院心血管外科全军心脏外科研究所,北京100853

出　　处：《中华胸心血管外科杂志》2009年第5期332-334,共3页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的比较糖尿病病人非体外循环和经典体外循环冠状动脉旁路移植（OPCAB和CCABG）的术后早期临床结果。方法1999年4月至2008年1月，318例糖尿病病人行冠状动脉旁路移植术（CABG）。OPCAB210例，CCABG108例。两组术前总体情况差异无统计学意义。OPCAB在非体外循环、心脏跳动下完成，CCABG在体外循环、心脏停跳下完成。正中开胸，胸膜外游离带蒂左乳内动脉（LIMA），与左前降支（LAD）吻合，大隐静脉（GSV）与其他靶血管吻合，吻合口超过2个采用序贯吻合。术前口服降糖药或皮下注射胰岛素将血糖控制在6mmol／L以下，术后早期在ICU时持续泵入胰岛素，将血糖控制在6—8mmol／L。结果两组共5例（1．57％）死亡，7例（2．20％）发生并发症。两组均达到完全再血管化，平均移植旁路血管OPCAB组（2．6±1．1）支，低于CCABG组的（3．1±1．3）支，P〈0．05。OPCAB组死亡1例（0．48％），明显低于CCABG组4例（3．70％），P〈0．05。OPCAB组发生并发症5例（2．30％），CCABG组2例（1．85％），组间差异无统计学意义，P〉0．05。结论糖尿病者冠状动脉旁路移植手术围术期严格控制血糖至接近正常水平，住院病死率和并发症率低。OPCAB术后早期病死率明显低于CCABG。Objective Coronary artery bypass grafting （CABG） is typically performed with ou-pump eardiopulmouary bypass （CPB） or extracorporeal circulation, which is safe and effective. However, CPB may cause systemic inflammation with resultant damage to the heart, brain, hver, lung and kidney, as well as blood coagulation and immune system. Off pump coronary artery bypass （OPCAB） is superior to the on-pump CABG （conventional coronary artery bypass grafting, CCABG） in avoiding adverse effects assodated with CABG. We described the early outcomes with OPCAB in comparison with CCABG in patients with diabetes mellitus. Methods From April of 1999 to January 2008, three hundred eighteen CABGs were performed in patients with diabetes, including 210 cases of OPCAB and 108 eases of CCABG. After full stemotomy, left internal mammary artery （LIMA） was harvested and anastomescal to left anterior descending artery （LAD）. Other target vessels were revasoularized with great saphenous vein （GSV） and sequential anastomosis was used if more than two anastomotie stoma were required. OPCAB was performed on the beating heart without cardiopulmonary bypass （CPB） and CCABG performed on the arrested heart under CPB. Blood glucose （BG） was controlled preopera- tively at less then 6 mmol/L with oral medication or subcutaneous insulin, and was controlled with insulin infusion postoperatively while patients were remaining at ICU, with target level of glucose at 6 to 8 mmol/L. Results Overall, no differenco was observed betwecn two groups at baseline. Five in-hospital deaths （1.57%） and 7 complications （2.20%） occurred. Complete revascularization was achieved in beth groups. The mean grafts （ 2.6 ± 1.1 ） in the OPCAB group was less than that （3.1 ±1.3） in the CCABG group （P〈0.05）. Mortality in the OPCAB group （one case, 0.48%） was significantly lower than that in the CCABG group （4 eases, 3.70%）. No significant difference in the incidence of complications was observed between the two g

关 键 词：冠状动脉旁路移植术 非体外循环 心肺转流术 糖尿病 

分 类 号：R686[医药卫生—骨科学]