左胸前外侧小切口与胸骨下段小切口微创冠状动脉旁路移植术治疗冠心病效果观察  

Clinical outcomes of minimally invasive direct coronary artery bypass grafting via left anterolateral ministernotomy versus distal ministernotomy in the treatment of coronary heart disease

作　　者：刘华伟 程兆云 胡俊龙 葛振伟 王保才 徐高俊 赵勇 刘前进 LIU Hua-wei;CHENG Zhao-yun;HU Jun-long;GE Zhen-wei;WANG Bao-cai;XU Gao-jun;ZHAO Yong;LIU Qian-jin(Department of Adult Cardiac Surgery,Zhengzhou University People's Hospital,Heart Center of Henan Provincial People's Hospital,Fuivai Central China Cardiovascular Hospital,Zhengzhou,Henan 450003,China)

机构地区：[1]郑州大学人民医院河南省人民医院心脏中心阜外华中心血管病医院成人心外科,河南郑州450003

出　　处：《中华实用诊断与治疗杂志》2022年第4期365-369,共5页Journal of Chinese Practical Diagnosis and Therapy

基　　金：国家自然科学基金(31970766);河南省医学科技攻关计划项目(2018020438);河南省医学教育联合共建项目(Wjlx2020167)。

摘　　要：目的 探讨冠心病患者采用左胸前外侧小切口与胸骨下段小切口微创冠状动脉旁路移植术治疗的临床效果及术后并发症发生情况。方法 单纯左前降支病变冠心病患者86例,均行微创冠状动脉旁路移植术治疗,其中采用左胸前外侧小切口入路者48例为左胸前外侧组,采用胸骨下段小切口入路者38例为胸骨下段组,术中均行左乳内动脉与左前降支吻合单支搭桥。比较2组年龄、男性比例、体质量指数、糖尿病、高血压、脑血管病史、NYHA心功能分级及术前肌红蛋白、血肌酐水平等临床资料;比较2组手术切口长度、术中出血量、桥血管流量、搏动指数、手术时间、术后呼吸机使用时间、ICU治疗时间、术后视觉模拟疼痛评分、术后住院时间、术后24 h引流量及术后新发心房颤动、切口愈合不良、急性肾损伤、低氧血症并发症发生情况;随访1年,比较2组随访期间桥血管通畅率。结果 2组年龄、体质量指数、男性比例、糖尿病、高血压、脑血管病史、NYHA心功能分级及术前肌红蛋白、血肌酐水平比较差异均无统计学意义(P>0.05)。左胸前外侧组手术切口长度[(7.04±1.03)cm]、术后呼吸机使用时间[(10.56±5.93)h]、ICU治疗时间[(20.05±14.36)h]、术后住院时间[(6.55±2.71)d]均短于胸骨下段组[(10.08±1.12)cm、(13.67±6.36)h、(25.85±7.14)h、(8.06±3.04)d](P<0.05),术后24 h引流量[(177.56±131.03)mL]少于胸骨下段组[(268.95±191.02)mL](t=-2.107,P=0.040),术后疼痛视觉模拟评分[(6.24±0.79)分]高于胸骨下段组[(4.86±0.85)分](t=4.564,P<0.001)。2组手术时间、术中出血量、桥血管流量、搏动指数比较差异均无统计学意义(P>0.05)。2组术后均无二次开胸止血、脑血管意外及围手术期心肌梗死情况发生;2组术后新发心房颤动、切口愈合不良、急性肾损伤、低氧血症发生率比较差异均无统计学意义(P>0.05)。随访1年,左胸前外侧组失访Objective To investigate the clinical outcomes and postoperative complications of minimally invasive direct coronary artery bypass grafting(CABG) via left anterolateral ministernotomy and distal ministernotomy in patients with coronary heart disease. Methods A total of 86 patients with isolated left anterior descending artery disease underwent minimally invasive direct CABG, among which 48 patients received left anterolateral ministernotomy approach(left anterolateral ministernotomy group), and the other 38 patients received lower ministernotomy approach(distal ministernotomy group). All patients underwent a single anastomosis with the left internal mammary artery to the left anterior descending artery. The clinical data as age, male ratio, body mass index, percentages of patients with diabetes mellitus,hypertension and cerebrovascular disease history,NYHA cardiac functional classification,and preoperative levels of myoglobin and serum creatinine were compared between two groups.The length of surgical incision,intraoperative blood loss,blood flow of the graft,pulsation index,operation lasting time,duration of postoperative ventilation,length of ICU stay,postoperative visual analogue scale,length of hospital stay,drainage volume in 24hafter operation,postoperative newly-onset atrial fibrillation,poor incision healing,acute kidney injury,hypoxemia and other complications were compared between two groups.After 1-year follow-up,the incidence of graft patency was compared between two groups.Results There were no significant differences in the age,body mass index,male ratio,percentages of patients with diabetes mellitus,hypertension and cerebrovascular disease history, NYHA cardiac function classification,and preoperative levels of myoglobin and serum creatinine between two groups(P>0.05).The length of surgical incision,duration of postoperative ventilation,length of ICU stay and length of postoperative hospital stay were shorter in left anterolateral ministernotomy group[(7.04±1.03)cm,(10.56±5.93)h,(20.05±14.36)h,(

关 键 词：冠心病 微创冠状动脉旁路移植术 左前降支 左胸前外侧小切口 胸骨下段小切口 

分 类 号：R654.2[医药卫生—外科学]