非体外循环冠状动脉旁路移植术治疗高危冠心病的疗效评价  

Efficacy evaluation of off-pump coronary artery bypass grafting for treating high risk coronary artery disease

作　　者：刘胜中[1] 谭今[1] 于涛[1] 黄克力[1] 

机构地区：[1]四川省医学科学院/四川省人民医院/中国科学院四川转化医学研究医院心脏外科中心,成都610072

出　　处：《重庆医学》2017年第10期1323-1325,1329,共4页Chongqing medicine

基　　金：中国科学院2014年度"西部之光"人才培养计划资助课题(30305031013)

摘　　要：目的探讨非体外循环冠状动脉旁路移植术(OPCABG)治疗高危冠心病[中国冠状动脉旁路移植手术风险评估系统(SinoSCORE)评分大于或等于6分]的临床经验,并评价其安全性和疗效。方法回顾性分析2012年4月至2015年12月在该中心接受OPCABG治疗的73例高危冠心病患者(高危组)的临床资料,并与同期手术治疗的78例中低危患者(SinoSCORE评分小于6分,中低危组)进行对比分析。结果全组手术均顺利完成。与中低危组相比,高危组的乳内动脉使用率明显减少(P<0.05),手术时间、呼吸机辅助时间、ICU入住时间和术后住院时间明显延长(P<0.05),主动脉内球囊反搏使用率明显增加(P<0.05),术后严重并发症发生率亦明显增加(P<0.05)。术后69例随访(18.3±8.6)个月,2例死亡。18例经冠状动脉血管成像或冠状动脉造影检查证实11支乳内动脉桥通畅(11/11),38支大隐静脉桥通畅(38/43)。1例患者心绞痛复发行PCI治疗,其余患者无心绞痛症状,生活质量良好。结论 OPCABG是一种相对微创且安全的手术方式,通过强化围术期处理,可以降低高危冠心病患者的手术风险,并能取得良好的近中期疗效。Objective To summarize the clinical experience of off-pump coronary artery bypass grafting （OPCABG） for trea- ting high risk coronary artery disease （CAD,SinoSCORE ≥ 6 points） ,and to evaluate its safety and efficacy. Methods The clinical data of 73 patients with high risk coronary artery disease treated through OPCAt3G （high risk group） in our center from April 2012 to December 2015 were retrospectively analyzed and compared with those of other low or moderate risk 78 patients treated throughOPCABG （SinoSCORE≥ 6 points,low or moderate risk group） at the same period. Results All operations in the high risk group were successfully performed. Compared with the low or moderate risk group,the rate of using left internal mammary artery grafts in the high risk group was reduced significantly （P〈0.05）, the operation time, postoperative ventilator support time, postoperative in- tensive care unit stay time and postoperative hospitalization time were prolonged significantly （P〈0.05）, the rate of using intra- aortic balloon pump support was increased significantly （P〈0.05）, and the occurrence rate of postoperative severe complications was also increased significantly （P〈0.05）. Sixty-nine cases were postoperatively followed up for （18.3±8.6） months. During the following-up period,2 cases died. 11 branches of internal mammary artery grafts patency （11/11） and 38 branches Of great saphe- nous vein grafts patency （38/43） were confirmed in 18 cases by coronary artery computer tomography angiography or coronary an- giography. One cases was performed the PCI therapy due to angina relapse,and other cases had no angina symptoms with good life quality. Conclusion OPCABG is a relatively minimally invasive and safe operative mode. Strengthening perioperative management can reduce the operation risk and achieves＂ good short or middle term efficacy in the patients with high risk CAD,

关 键 词：非体外循环冠状动脉旁路移植术 冠心病 高危 治疗结果 

分 类 号：R654.2[医药卫生—外科学]