全动脉化冠状动脉旁路移植术在左心室功能低下患者中的应用  

Clinical outcomes of total arterial off-pump coronary revascularization in patients with left ventricular dysfunction

作　　者：孙勇新 丁文军 夏利民 王春生 Sun Yongxin;Ding Wenjun;Xia Limin;Wang Chunsheng(Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Disease, Shanghai 200032, China)

机构地区：[1]复旦大学附属中山医院心外科上海市心血管病研究所,上海200032

出　　处：《中华医学杂志》2019年第14期1058-1062,共5页National Medical Journal of China

基　　金：国家自然科学基金(81671942).

摘　　要：目的比较全动脉化(TAR)和常规非体外循环冠状动脉旁路移植术(OPCAB)在合并左心室功能低下(LVD)冠心病患者中的优劣。方法2008年1月至2015年3月复旦大学附属中山医院心外科左心室射血分数≤35%行TAR-OPCAB术[取双侧乳内动脉、左侧和(或)右侧桡动脉]患者38例,年龄(60.4±11.6)岁,男32例。选取同期收治的年龄、性别相匹配的常规OPCAB术(取左乳内动脉和大隐静脉)患者38例为对照组。收集整理所有入选患者术前、术中及围手术期临床资料。术后随访36个月,比较两组患者随访结果。结果两组患者术前临床资料差异均无统计学意义(均P>0.05)。两组乳内动脉应用率、正性肌力药物应用和主动脉内球囊反搏(IABP)辅助方面差异均无统计学意义(均P>0.05)。TAR组与对照组相比,手术时间较长[(278.3±31.2)min比(196.7±19.1)min,P<0.01],术后24h胸腔引流量及输血量较多[(895.0±236.2)ml比(585.4±172.5)ml,(656.3±84.4)ml比(433.3±62.9)ml,均P<0.01]。两组患者围手术期死亡率差异无统计学意义(5.3%比7.9%,P=0.64)。在心、肾、肺等围手术期并发症方面,两组差异均无统计学意义(均P>0.05)。术后12个月,患者存活率、心因性死亡率、心绞痛再发、心肌梗死、再次血管化治疗率、心功能不全再次住院率、桥血管通畅率、心功能分级及心脏超声数据,两组差异均无统计学意义(均P>0.05)。术后24~36个月,TAR组上述各项指标,除心脏超声数据外均优于对照组(均P<0.05)。结论对于LVD患者,早期临床疗效两种术式相近,但在中远期临床疗效上,TAR-OPCAB术明显占优。而TAR-OPCAB术缺点在于术后胸腔引流量及血制品使用上明显增多。Objective To compare the advantages and disadvantages of total arterial revascularization (TAR) and conventional off-pump coronary artery bypass (OPCAB) grafting in patients with left ventricular dysfunction (LVD). Methods Between January 2008 and March 2015, 76 patients who were scheduled to undergo selective OPCAB were selected for cardiac surgery in Zhongshan Hospital, Fudan University. The left ventricular ejection fraction of enrolled patients was less than 35%. Among those patients, 38 patients in TAR group underwent total arterial OPCAB with bilateral internal mammary artery, left and/or right radial artery, and another 38 patients in control group underwent conventional OPCAB with left internal mammary artery and great saphenous vein. The clinical data of all patients were collected. The follow-up was performed within 36 months. Results There was no significant difference in preoperative clinical data between the two groups (all P>0.05). Additionally, there was no significant difference in the application rate of internal mammary artery, positive inotropic drugs and intra-aortic balloon pump (IABP) use between the two groups (all P>0.05). The operation time of TAR group was longer than that of control group [(278.3±31.2) min vs (196.7±19.1) min, P<0.01]. There was no significant difference in perioperative mortality between the two groups (5.3% vs 7.9%, P=0.64). The volume of operative drainage and blood transfusion in TAR group increased significantly at 24 hours after operation [(895.0±236.2) ml vs (585.4±172.5) ml,(656.3±84.4) ml vs (433.3±62.9) ml, both P<0.01]. There was no significant difference in perioperative complications such as heart, kidney and lung failure between the two groups (all P>0.05). At 12 months after operation, there were no significant differences in survival rate, cardiac death rate, angina recurrence, myocardial infarction, re-treatment rate of revascularization, re-hospitalization rate from cardiac insufficiency, graft patency rate, cardiac function and echocardiographic

关 键 词：冠状动脉旁路移植术 非体外循环 冠状动脉疾病 心室功能障碍 左 全动脉化血运重建 

分 类 号：R654.2[医药卫生—外科学]