体外循环与非体外循环冠状动脉旁路移植术早期疗效分析  

Analysis of early outcomes of on-pump coronary artery bypass grafting and off-pump coronary artery bypass grafting

作　　者：李扬[1] 屈正[1] 张兆光[1] 

机构地区：[1]首都医科大学附属北京安贞医院心脏外科,北京100029

出　　处：《心脏杂志》2011年第4期487-492,共6页Chinese Heart Journal

摘　　要：目的：探讨体外循环冠状动脉旁路移植术（CCABG）和非体外循环冠状动脉旁路移植术（OPCABG）早期疗效的差异。方法：采集自2003年10月-2008年1月我院单纯冠状动脉旁路移植术5325例临床资料，分为CCABG组（343例）与OPCABG组（4982例）。对两组患者各项术前因素、术中因素、手术死亡率及并发症进行比较。结果：OPCABG组实际手术死亡率（1．7％）明显低于CCABG组（6．7％），P〈0．01；术后二次开胸止血、肾功能不全等并发症的发生率及ICU停留时间、呼吸机辅助时间、术后住院时间都低于CCABG组（P〈0．05，P〈0．01）。风险调整后CCABG组手术死亡率仍高于OPCABG组6个百分点，术后并发症的发生率均略高于OPCABG组（P〈0．05）。结论：CCABG与OPCABG早期临床疗效均令人满意，后者更好一些。AIM： To analyze the difference of the early outcome between conventional coronary artery bypass grafting （CCABG） and off-pump coronary artery bypass grafting （OPCABG）. METHODS： A total of 5325 CABG consecutive cases in our hospital from October 2003 to January 2008 were divided into OPCABG group （n = 4 982） and CCABG group （n = 343）. Early outcomes of all patients were analyzed and risk-adjusted mortality and incidence rates of complications were computed using a predictive equation derived by stepwise logistic regression. RESULTS ： The mortality in the OPCABG group （ 1.7% ） was much lower than in CCABG group （6.7% , P 〈0. 01 ）. In OPCABG group, postoperative ventilation time （20 ± 15 vs. 31 ±31 h, P 〈0. 01）, length of stay in intensive care unit （28±26 vs. 48 ±47 h, P 〈 0. 01 ） and hospitalization time （13±9 vs. 16 ± 11 days, P 〈0. 01 ） were shorter, and the incidence of complications such as hemostasis （ 1.6 vs. 6. 1%, P 〈 0. 01 ） and renal insufficiency （0. 8 vs. 2. 6% , P 〈0. 01 ） was lower. After comorbidity adjustment, the mortality rate in CCABG group remained 6% higher than in OPCABG group, and the rate of complications in CCABG group was slightly higher compared with that in OPCABG group. CONCLUSION： Compared with CCABG, OPCABG achieves better early outcome but the medium- and long-term results need to be further followed up.

关 键 词：冠状动脉旁路移植术 体外循环 死亡率 并发症 

分 类 号：R541.4[医药卫生—心血管疾病]