非体外循环下冠状动脉旁路移植术中转体外循环停跳方式的选择  

The choice of whether or not to stop beating after conversion to cardiopulmonary bypass in off-pump coronary artery bypass grafting

作　　者：赵铁夫[1] 王盛宇[1] 张春晓[1] 张明[1] 曾文[1] 王坚刚[1] 郑帅[1] 陈宏[1] ZHAO Tiefu;WANG Shengyu;ZHANG Chunxiao;ZHANG Ming;ZENG Wen;WANG Jiangang;ZHENG Shuai;CHEN Hong(Department of Cardiac Surgery,Beijing Anzhen Hospital,Capital Medical University,Beijing,100029,P.R.China)

机构地区：[1]首都医科大学附属北京安贞医院心脏外科,北京100029

出　　处：《中国胸心血管外科临床杂志》2021年第8期954-958,共5页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的探讨在非体外循环下冠状动脉旁路移植术(CABG)中转为体外循环辅助时是否停跳与手术效果的关系。方法 2016~2018年北京安贞医院行非体外循环CABG术中转行体外循环辅助的手术患者177例。根据术中心脏是否停跳,将患者分为两组:不停跳组:76例,男45例、女31例,年龄(63.53±6.98)岁,应用体外循环下不停跳CABG;停跳组:101例,男66例、女35例,年龄(63.98±8.37)岁,应用体外循环下改良灌注CABG。比较两组临床效果。结果全部患者围术期死亡14例。停跳组桥血管平均流量高于不停跳组(P=0.033),桥血管搏动指数低于不停跳组(P=0.001),两组在主动脉内球囊反搏(P=0.036)、体外膜肺氧合(P=0.038)、连续性肾脏替代治疗(P=0.014)、呼吸机辅助时间(P=0.021)、ICU监测时间(P=0.012)、围术期死亡率(P=0.025)和术后6 d射血分数(P=0.023)方面差异有统计学意义。结论非体外循环CABG中转体外循环辅助下改良灌注的停跳CABG较不停跳CABG能够得到更好的围术期临床效果,是值得推荐的手术方式。Objective To explore the effect of whether or not to stop beating after conversion to cardiopulmonary bypass(CPB)in off-pump coronary artery bypass grafting.Methods From 2016 to 2018,177 patients with off-pump coronary artery bypass grafting in Beijing Anzhen Hospital were transferred to CPB.According to whether they stopped beating after conversion to CPB during the operation,they were divided into two groups.A non-stop beating group:there were 76 patients with 45 males,31 females.aged 63.53±6.98 years,who were not to stop beating after conversion to CPB.A stop beating group:there were 101 patients with 66 males and 35 females,aged 63.98±8.37 years,who were to stop beating and underwent the modified perfusion and application of papaverine in perfusion after conversion to CPB.The clinical effect of the two groups was compared.Results There were 14 deaths in the perioperative period.The mean graft flow(MGF)in the stop beating group was higher(P=0.033),and the pulse index(PI)was lower(P=0.001)than those in the non-stop beating group.Intra-aortic balloon counter pulsation(P=0.036),extracorporeal membrane oxygenation(P=0.038),continuous renal replacement therapy(P=0.014),ventilator-assisted time(P=0.021),ICU monitoring time(P=0.012),perioperative mortality(P=0.025)and the ejcetion fraction value(P=0.023)were significantly different between the groups.Conclusion Compared with not to stop beating,those to stop beating can get better perioperative clinical effect after conversion to CPB,which is worthy of recommendation.

关 键 词：冠状动脉旁路移植术 体外循环 不停跳 术式改变 

分 类 号：R654.2[医药卫生—外科学]