"一站式"颈动脉支架置入加不停跳冠状动脉旁路移植治疗重度冠心病合并颈动脉狭窄的早期疗效分析  

Early effects of simultaneous carotid artery stenting combined with off-pump coronary artery bypass grafting in the treatment of severe coronary heart disease complicated with carotid artery stenosis

作　　者：梁林[1] 郑铁晋[1] 柳佳吉 马小龙[1] 潘锋 耿丹青 赵广鑫 迟立群[1] Liang Lin;Zheng Tiejin;Liu Jiaji;Ma Xiaolong;Pan Feng;Geng Danqing;Zhao Guangxin;Chi Liqun(Department of Cardiac Surgery,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院心外科,北京100029

出　　处：《中华胸心血管外科杂志》2022年第2期80-83,共4页Chinese Journal of Thoracic and Cardiovascular Surgery

基　　金：北京市科技计划项目(Z201100005520086)。

摘　　要：目的通过对比"一站式"同期颈动脉支架置入术(carotid artery stenting,CAS)+非体外循环下冠状动脉旁路移植术(off-pump coronary artery bypass grafting,OPCABG)和分期序贯CAS+OPCABG两种术式围手术期情况及早期随访资料,评估"一站式"同期手术的安全性和有效性。方法北京安贞医院自2020年1月至2021年7月因冠心病合并颈动脉狭窄行CAS+OPCABG杂交手术的患者共26例,其中12例采用了"一站式"同期CAS+OPCABG、14例采用了分期序贯CAS+OPCABG,对其围手术期及术后3个月随访资料进行对比分析。连续变量采用t检验,计数资料采用χ^(2)检验。结果两组的累计手术时间、术后第1天胸腔引流量、呼吸机辅助、ICU滞留差异均无统计学意义(P>0.05)。同期组术中出血量多于分期组,但两组均无二次开胸止血发生。术后住院天数同期组显著少于分期组。分期组围手术期发生脑梗塞、心肌梗死各1例,同期组无围手术期心肌梗死及脑梗塞发生,但两组间差异无统计学意义(P>0.05)。术后3个月随访两组均无新发脑梗塞,颈动脉超声支架均通畅,心功能分级和左心室射血分数差异无统计学意义(P>0.05)。结论"一站式"同期CAS+OPCABG手术是安全可行的,尤其对于心肌缺血症状重或重度左主干病变的患者推荐首选同期手术。优化抗凝方案和减轻颈动脉窦反射是需要继续研究的主要问题。Objective The perioperative and early follow-up data of the simultaneous hybrid CAS+OPCABG and sequential CAS+OPCABG were compared to evaluate the safety and efficacy of the simultaneous CAS+OPCABG.Methods A total of 26 patients with coronary heart disease complicated with carotid artery stenosis received CAS plus OPCABG hybrid surgery in our hospital from January 2020 to July 2021,among which 12 patients received simultaneous CAS+OPCABG and 14 patients received staged sequential CAS+OPCABG.The perioperative and postoperative follow-up data of 3 months were compared and analyzed.Results There were no significant differences in the operation time,drainage on the first day after surgery,ventilator assisted time and ICU time between the two groups.The amount of intraoperative blood loss in the simultaneous group was more than that in the staged group,but no secondary thoracotomy occurred in both groups.The number of days in hospital after operation was significantly less in the simultaneous group.There was 1 case of perioperative cerebral infarction and 1 case of myocardial infarction in the staged group,but there was no statistical difference between the two groups.There was no new cerebral infarction in the two groups,carotid artery ultrasound stent was unobstructed,and there was no statistical difference in cardiac function grading and left ventricular ejection fraction 3 months after operation.Conclusion Simultaneous CAS+OPCABG surgery is safe and feasible,it is recommended as the first choice especially for patients with severe myocardial ischemiaor severe left main artery disease caused.How to reduce the risk of bleeding and alleviat carotid sinus reflex are major issues that need to be concerned.

关 键 词：杂交手术 同期手术 颈动脉支架置入术 冠状动脉旁路移植术 

分 类 号：R654.2[医药卫生—外科学]