一站式杂交技术与传统手术治疗复杂冠心病的临床研究  

Comparative study of one-stop hybrid cardiac surgery with conventional coronary artery bypass surgery for patients with complex coronary heart disease

作　　者：滕志华[1,2] 董爱强[1] 孔敏坚[1] 程海峰[1] 沈中华[1] 钱建芳[1] 

机构地区：[1]浙江大学医学院附属第二医院心脏大血管外科,杭州在职研究生310009 [2]义乌市中心医院

出　　处：《浙江医学》2015年第10期816-819,共4页Zhejiang Medical Journal

摘　　要：目的比较一站式杂交技术与胸骨正中切口体外循环冠脉搭桥术的效果和并发症,对一站式杂交技术的疗效和安全性作系统评价。方法选择行一站式冠脉杂交手术(杂交组)34例和胸骨正中切口体外循环冠脉搭桥术(传统组)34例患者,经左胸小切口在不停跳状态下行左乳内动脉至前降支旁路移植术,手术结束后即行经皮冠状动脉介入治疗(PCI),术后口服阿司匹林及氯吡格雷抗凝。比较两组患者术中、术后及并发症情况。结果两组患者围术期均无死亡病例。杂交组的手术时间[(257.6±49.1)min]较传统组[(387.0±57.1)min]短,术中出血量[(312.5±86.1)ml]较传统组[(796.9±161.6)ml]少(均P<0.05),而传统组开通靶血管数[(3 7±0.8)支]比杂交组[(2.9±0.6)支]多(P<0.05)。术后杂交组ICU停留时间[(52.5±23.0)h]、机械通气时间[(18.3±15.1)h]、住院时间[(11.1±2.9)d]较传统组[分别为(122.2±31.3)h、(36.8±22.6)h、(17.7±5.5)d]短(均P<0.05),而术后杂交组引流量[(657.6±17.8)ml]及住院费用[(12.8±1.7)万元]均较传统组[分别为(484 3±228.4)ml、(10.5±2 3)万元]多(P<0.05),但术后输血量无统计学差异(P>0 05)。两组均无院外死亡病例,无脑血管意外、心绞痛或心肌梗死再发。结论一站式杂交技术治疗复杂冠心病安全、有效,与传统手术比较,创伤更小、恢复更快,值得临床推广应用。Objective To compare the efficacy and safety of one-stop hybrid cardiac surgery with conventional coronary artery bypass surgery for patients with complex coronary heart disease. Methods Clinical data of 68 patients with complex coronary heart disease treated in our hospital from November 2011 to May 2014 were retrospectively reviewed, including 34 patients received one-stop hybrid cardiac surgery （group1） and 34 patients received converntional coronary artery bypass surgery （group2）. The efficacy and complications were compared between two groups. Results There was no death case related to surgery in both groups. There were no significant differences in age, sex, grade of cardiac function and complications between two groups（P 〉0.05）. The operation time（257.6 ±49.1 min）, intraoperative blood Iost（312.5 ± 86.1 ml） in group1 were less than those in group2 （P〈0.05）; the mean number of revascularization in group 1 （2.9 ± 0.6 per patient） was less than that in group 2 （3.7 ± 0.8 per patient）（P〈0.05）. The length of ICU stay, duration of postoperative mechanical ventilation and length of hospital stay in group 1 were 122.2 ±31.3 h, 18.3± 15.1 h and 11.1 ±2.9 d respectively, which were all shorter than those in group 2 （52.5 ± 23.0 h, 36.8 ±22.6 h and 17.7 ±5.5 d, all P〈0.05）. The chest drainage volume （657.6 ±17.8 ml） and medical expenses （128,000 ±17,000 Yuan） in group 1 were more than those in group 2 （484.3 ±228.4 ml and 10,5000 ±23,000 Yuan, P〈0.05）; however, there was no difference in postoperative blood transfusion（P〈0.05）. There were no deaths after discharge, cerebrovascular accident, recurrent angina pectoris or myocardial infarction in both groups during the follow-up period （13.0±3.8 months in group 1 and 14.3 ±2.9 months in group 2）. Conclusion One-stop hybrid technology for treatment of complex coronary artery disease is safe and effective with less trauma and quick recovery; and is worthy of clinical application.

关 键 词：冠状动脉疾病 冠状动脉旁路移植术 经皮冠状动脉介入治疗 杂交技术 病例对照研究 

分 类 号：R541.4[医药卫生—心血管疾病]