冠状动脉旁路移植术中采用多支动脉与单支乳内动脉的围术期结局倾向性匹配研究  

Multiple Versus Single Arterial Coronary Artery Bypass Grafting Surgery:A Propensity Score Matched Study of In-hospital Outcomes

作　　者：田美策 胡盛寿[1] 吴岳[1] 袁昕[1] 王立清[1] 王现强[1] 张昌伟[1] 金泽建 刘凯飏 TIAN Mei-ce;HU Sheng-shou;WU Yue;YUAN Xin;WANG Li-qing;WANG Xian-qiang;ZHANG Chang-wei;JIN Ze-jian;LIU Kai-yang(Department of Cardiology,Fuwai Hospital,National Cardiovascular Center,Peking Union Medical College,Chinese Academy of Medical Sciences,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,阜外医院心外科,北京市100037

出　　处：《中国分子心脏病学杂志》2021年第3期3967-3972,共6页Molecular Cardiology of China

基　　金：科技体制改革中国医学科学院阜外医院青年基金项目“No-Touch(不接触)大隐静脉获取技术在下肢不同部位的探索性研究”(2019-F06)。

摘　　要：目的比较采用多支动脉与左乳内动脉+大隐静脉桥血管组合的单支动脉冠状动脉旁路移植(coronary artery bypass grafting,CABG)手术的围术期结局。方法回顾阜外医院在2009-2019年完成的单纯CABG,按使用的旁路血管类别分为多支动脉与单支动脉CABG组,采用倾向性匹配法调整基线差异,比较两组的围术期资料及院内结局,从而评估多支动脉CABG是否与术后主要并发症的发生风险相关。结果共纳入患者34915例,其中多支动脉组1305例,单支动脉组33610例,匹配后组间比较显示多支动脉组的手术时间[326.6(286.5~361.3)min,277.0(243.0~315.0)min,P<0.001]、体外循环时间[104.0(88.0~123.0)min,95.0(79.0~116.0)min,P<0.001]、主动脉阻断时间[72.0(66.0~86.0)min,64.0(52.0~80.0)min,P<0.001]均较单支动脉组显著延长,多支动脉组的血制品使用(OR=1.28,95%CI:1.06~1.55,P=0.01)及红细胞使用(OR=1.39,95%CI:1.13~1.73,P<0.01)均显著高于单支动脉组。院内死亡率以及其他并发症在两组间无显著差异。结论与左乳内动脉+大隐静脉的单支动脉CABG手术方案相比,多支动脉的CABG显著延长了手术时间,且增加了术后输血及红细胞使用。Objective To compare the in-perioperative outcomes between patients receiving multiple-arterial CABG and single-arterial CABG(using left internal mammary artery plus saphenous vein graft).Methods All patients receiving isolated CABG surgery in Fuwai Hospital from 2009 to 2019 were screened.Eligible patients were divided into multi-arterial group and single-arterial group based on bypass graft materials.In-hospital outcomes were compared in the propensity score matched treatment groups.Results A total of 34915 patients were included in the study,including 1305 patients underwent multi-arterial CABG and 33610 patients received single-arterial CABG.After matching,the comparison between the two groups showed that the operation time[326.6(286.5-361.3)min vs 277.0(243.0-315.0)min,P<0.001],cardiopulmonary bypass time[104.0(88.0-123.0)min vs 95.0(79.0-116.0)min,P<0.001],the aortic occlusion time[72.0(66.0-86.0)min vs 64.0(52.0-80.0)min,P<0.001]was significantly longer than that in the single artery group.In multi-arterial CABG group,blood products use(OR=1.28,95%CI:1.06-1.55,P=0.01)and red blood cell use(OR=1.39,95%CI:1.13-1.73,P<0.01)were significantly higher than those in single-arterial CABG group.There was no significant difference in hospital mortality and other complications between the two groups.Conclusion Compared with single-arterial CABG using LIMA plus SVG,multi-arterial CABG was associated with longer operative time,higher rate of blood transfusion,and higher rate of red blood cell transfusion.

关 键 词：冠状动脉旁路移植术 多支动脉冠状动脉旁路移植 输血 

分 类 号：R654.2[医药卫生—外科学]