全动脉化冠状动脉旁路移植术患者院内结局的病例对照研究  

In-hospital outcomes of total arterial coronary artery bypass grafting surgery:A retrospective case-control study

作　　者：田美策 吴岳[1] 袁昕[1] 王现强[1] 王立清[1] 张昌伟[1] 刘凯飏 金泽健 胡盛寿[1] Tian Meice;Wu Yue;Yuan Xin;Wang Xianqiang;Wang Liqing;Zhang Changwei;Liu Kaiyang;Jin Zejian;Hu Shengshou(Department of Adult Cardiac Surgery,Fuwai Hospital,National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China)

机构地区：[1]中国医学科学院,北京协和医学院,国家心血管病中心,阜外医院成人外科中心,北京100037

出　　处：《中国体外循环杂志》2021年第3期163-168,共6页Chinese Journal of Extracorporeal Circulation

摘　　要：目的评价采用全动脉化与常规左乳内动脉+大隐静脉桥血管组合的冠状动脉旁路移植术(CABG)患者的院内结局差异。方法回顾性分析本院在2009年至2019年间完成的单纯CABG患者,按采用的桥血管种类分为全动脉组与左乳内动脉+大隐静脉的对照组,通过倾向性匹配法比较两组间在围术期资料及院内结局及并发症方面有无差异,评估全动脉CABG是否与术后主要并发症的风险相关。结果研究共纳入患者33876例,其中全动脉组266例,对照组33610例,倾向性评分匹配后显示全动脉组的手术时间较对照组显著延长(P<0.001),远端吻合口数明显少于对照组(P<0.001),全动脉组的血制品使用率(P=0.008)、红细胞输注率(P<0.001)、术后房颤的发生率均显著高于对照组(P=0.01)。院内死亡率以及其他并发症在两组间无显著差异。结论与对照组的CABG手术方案相比,全动脉化CABG显著延长了手术时间,且增加了术后输血及房颤发生的风险。Objective The in-hospital outcomes of total arterial coronary artery bypass grafting surgery(CABG)in Chinese patient population is less studied.Our study aims to compare the in-hospital outcomes between total arterial CABG and the conventional CABG using left internal mammary artery plus saphenous vein graft(SVG).Methods All patients undergoing isolated CABG in our hospital from 2009 to 2019 were screened.According to graft materials used,eligible patients were divided into total arterial group and control group(LIMA plus SVG).Operative outcomes were compared in the weighed treatment groups by propensity score matching with inverse probability treatment weighing(IPTW).Results A total of 33876 patients were included,among whom 266 patients received total arterial CABG,and 33610 received LIMA plus SVG CABG.Comparison of the weighed sample demonstrated that total arterial CABG was associated with longer operative time(β,25.1;95% confidence interval CI(14.0-36.2)),higher rate of blood transfusion(Odds Ratio,OR,1.06;95%CI(1.01-1.12)),more red blood cell transfusion(OR,1.07;95%CI(1.03-1.12)),and higher incidence of postoperative atrial fibrillation(OR,1.06;95%CI(1.01-1.11)).Other outcomes,such as in-hospital mortality and sternal wound infection,were of no significant difference.Conclusion Compared with conventional CABG using LIMA plus SVG,total arterial CABG was associated with longer operative time,higher rate of blood transfusion,and higher risk of postoperative atrial fibrillation.

关 键 词：冠状动脉旁路移植术 全动脉化 心脏手术 体外循环 疗效 

分 类 号：R654.2[医药卫生—外科学]