应用双侧乳内动脉实施“分站式”冠状动脉血运重建术治疗多支血管病变的安全性和有效性研究  

Efficacy and safety of “2-staged” Hybrid Coronary Revascularization Using Bilateral Internal Thoracic Artery Y Graft for Patients With Multivessel Coronary Artery Disease

作　　者：吴松[1] 凌云鹏[1] 傅元豪[1] 张鲁锋[1] 郭丽君[2] 高炜[2] 万峰[1] WU Song;LING Yun-peng;FU Yuan-hao;ZHANG Lu-feng;GUO Li-jun;GAO Wei;WAN Feng.(Department of Cardiac Surgery, Peking University Third Hospital, Beijing（100191）, China)

机构地区：[1]北京大学第三医院心脏外科,北京市100191 [2]北京大学第三医院心脏内科,北京市100191

出　　处：《中国循环杂志》2018年第5期424-428,共5页Chinese Circulation Journal

摘　　要：目的:探讨应用双侧乳内动脉(BITA)经左前外侧小切口实施"分站式"冠状动脉血运重建术(HCR)治疗冠状动脉多支血管病变的安全性和有效性。方法:选取2014-05至2017-05期间在我院应用BITA经左前外侧小切口实施"分站式"HCR治疗冠状动脉多支血管病变的65例患者,为BITA-HCR组;选取同一术者同期应用单侧乳内动脉(SITA)经左前外侧小切口实施HCR治疗冠状动脉多支血管病变的96例患者,作为SITA-HCR组。比较两组患者围手术期情况及并发症发生情况。结果:BITA-HCR组和SITA-HCR组的冠状动脉搭桥数[(2.2±0.5)支vs(1.0±0.0)支,P<0.0001]、微创冠状动脉旁路移植术(MIDCAB)手术时间[(204.6±28.7)min vs(147.9±31.6)min,P=0.004]、置入支架数[(1.90±0.67)枚vs(2.40±0.49)枚,P=0.0472]的差异有统计学意义;两组的外科手术后总引流量[(520.1±120.3)ml vs(532.2±350.3)ml,P=0.703]、输注红细胞例数[5(7.7%) vs 8(8.3%),P=0.484]、机械通气时间[(7.7±3.2)h vs(6.9±2.3)h,P=0.1373]、总住院时间[(12.7±3.2)d vs(13.7±3.6)d,P=0.5976]等方面的差异无统计学意义。经皮冠状动脉介入治疗(PCI)前冠状动脉造影证明,两组均未见桥血管吻合口狭窄、闭塞情况。术后平均随访1个月,两组患者无死亡、心绞痛或心肌梗死发生。结论:BITA用于经左前外侧小切口实施"分站式"HCR治疗冠状动脉多支血管病变,即可对左冠状动脉系统再血管化中实现全动脉化,也相应减少支架的应用,避免了大隐静脉桥的使用,其早期的临床结果显示安全性和可行性满意。Objectives： To explore the feasibility and safety of ＂2-staged＂ hybrid coronary revascularization using bilateral internal thoracic artery（BITA） for the treatment of multivessel coronary artery disease.Methods： Data of 65 patients who underwent ＂2-staged＂ hybrid technique（HCR） using BITA（BITA-HCR group） in our heart center because of multivessel coronary artery lesions during 2014.05-2017.05 were retrospectively analyzed. Results were compared with 96 patients who underwent ＂2-staged＂ HCR with single ITA（SITA-HCR group） by the same surgeon over the same time period.Results： There was no significant difference of preoperative characteristics between two groups. Operation time was significantly longer [（204.6±28.7） min vs（147.9±31.6） min, P〈0.05], number of distal anastomoses was significantly higher [（2.2±0.5） vs（1.0±0.0）, P〈0.05], number of stents was significantly lower [（1.90±0.67） vs（2.40±0.49）, P〈0.05] in BITA-HCR group than in SITA-HCR group. Bleeding volume [（520.1±120.3） ml vs（532.2±350.3）ml, P〈0.05], mechanical ventilation time [（7.7±3.2） h vs（6.9±2.3） h, P〈0.05] and blood transfusion required [5（7.7%）vs 8（8.3%）, P〈0.05] were similar betweenthe two groups. Conclusions： The ＂2-staged＂ hybrid procedure using BITA is safe and feasible for the revascularization of multiple coronary artery lesions.

关 键 词：微创冠状动脉旁路移植术 “分站式”血运重建 经皮冠状动脉介入治疗 

分 类 号：R54[医药卫生—心血管疾病]