非体外循环冠状动脉旁路移植术联合中度以上创伤非心脏手术的围手术期安全性研究及可行性评价  

Perioperative safety and feasibility of simultaneous off-pump coronary artery bypass grafting with non-cardiac surgical procedures of moderate-to-severe severity

作　　者：董士勇[1,2] 王进 张思宇[1] 张一丁[1] 杨阳 肖锋[1] Dong Shiyong;Wang Jin;Zhang Siyu;Zhang Yiding;Yang Yang;Xiao Feng(Department of Cardiac Surgery,Peking University First Hospital,Beijing 100034,China;Department of Cardiac Surgery,First Medical Center of People Liberation Army General Hospital,Beijing 100853,China)

机构地区：[1]北京大学第一医院心脏外科,100034 [2]解放军总医院第一医学中心心脏大血管外科,北京100853

出　　处：《中华外科杂志》2021年第1期46-51,共6页Chinese Journal of Surgery

摘　　要：目的探讨非体外循环冠状动脉旁路移植术(OPCAB)联合中度以上创伤非心脏手术的围手术期安全性及可行性。方法回顾性分析2013年9月至2019年1月在北京大学第一医院心脏外科行同期OPCAB联合非心脏手术54例患者的临床资料,男性46例,女性8例,年龄(65.8±8.8)岁(范围:41~85岁)。联合非心脏手术包括血管手术1例、胸外科手术26例、普通外科手术12例、泌尿外科手术15例,手术侵袭度评分均为中度以上创伤级别。每例患者选取相同心脏手术团队临近时间完成的、手术方式类似的另2例单纯OPCAB患者作为对照。采用t检验、Mann-Whitney U检验、χ²检验或Fisher确切概率法比较两组围手术期临床指标。结果两组患者术前各项基本指标基本匹配,欧洲心脏手术风险评估系统(EuroSCOREⅡ)评分无差异[1.185(0.758)%比1.215(0.905)%,Z=-0.036,P=0.972]。两组均无围手术期死亡患者。尽管同期联合手术组手术时间延长[(324.9±97.1)min比(166.7±36.7)min,t=11.564,P<0.01],且术中出血量增加[(462.2±269.6)ml比(304.5±177.8)ml,t=3.866,P<0.01],但两组主要术后并发症包括围手术期心肌梗死、新发心房颤动、围手术期卒中、急性肾功能不全、切口感染及出血再手术比例无差异(P值均>0.05),围手术期总输血量、机械通气时间及ICU停留时间也无差异(P值均>0.05)。结论对于符合指征的OPCAB患者,同期施行中度以上创伤的非心脏手术安全可行,与单纯OPCAB手术患者相比不增加围手术期并发症发生风险。Objective To examine the perioperative safety and feasibility of simultaneous off-pump coronary artery bypass grafting(OPCAB)with non-cardiac surgical procedures of moderate-to-severe severity.Methods The perioperative results of 54 patients underwent simultaneous OPCAB with non-cardiac surgical procedures from September 2013 to January 2019 at Department of Cardiac Surgery,Peking University First Hospital were assessed retrospectively.There were 46 males and 8 females,aging(65.8±8.8)years(range:41 to 85 years).All simultaneous non-cardiac surgical procedures,including vascular(n=1),thoracic(n=26),general(n=12)and urologic surgical procedures(n=15),were assessed to be of moderate-to-severe grade by operative severity scoring system.Perioperative results were compared between the OPCAB patients who underwent simultaneous non-cardiac surgical procedures(n=54)and 1∶2 matched patients who underwent isolated OPCAB performed most recently by the same cardiac team with similar procedures accordingly(n=108),using t test,Mann-Whitney U test,χ^(2) test or Fisher exact test.Results All baseline factors were matched between the two groups,with no significant difference on European system for cardiac operative risk evaluation(EuroSCORE)Ⅱ(1.185(0.758)%vs.1.215(0.905)%,Z=‒0.036,P=0.972).No perioperative death was observed in the two groups.Although patients underwent simultaneous non-cardiac surgical procedures showed prolonged operation duration time((324.9±97.1)minutes vs.(166.7±36.7)minites,t=11.564,P<0.01)and increased intraoperaive blood loss((462.2±269.6)ml vs.(304.5±177.8)ml,t=3.866,P<0.01),primary postoperative complications,including perioperative myocardial infarction,atrial fibrillation,perioperative stroke,acute renal failure,wound infection,and bleeding reoperation did not show significant differences between the two groups(all P>0.05),while total blood transfusion volume,mechanical ventilation time and intensive care unit residence time also showed no significant differences between the two groups(all

关 键 词：冠状动脉旁路移植术 非体外循环 外科手术 非心脏手术 

分 类 号：R657.3[医药卫生—外科学]