微创冠状动脉旁路移植术对冠心病多支病变的临床疗效评价  

Clinical efficacy evaluation of minimally invasive cardiac surgery coronary artery bypass grafting in patients with multivessel coronary artery disease

作　　者：张磊磊 谢周良[1] 权晓强[1] 丁付燕[1] Zhang Leilei;Xie Zhouliang;Quan Xiaoqiang;Ding Fuyan(Henan Provincial People′s Hospital Heart Center,Huazhong Fuwai Hospital,Zhengzhou University Huazhong Fuwai Hospital Adult Cardiac Surgery,Zhengzhou 450003,China)

机构地区：[1]河南省人民医院心脏中心,华中阜外医院,郑州大学华中阜外医院成人心脏外科,郑州450003

出　　处：《中华医学杂志》2022年第34期2696-2701,共6页National Medical Journal of China

基　　金：河南省卫生健康委2020年度河南省医学科技攻关计划联合共建立项(LHGJ20200093)。

摘　　要：目的探讨微创冠状动脉旁路移植术(MICS CABG)对多支冠状动脉病变冠心病的临床疗效。方法回顾性选取2016年3月至2019年3月河南省人民医院实施手术治疗的147例多支冠状动脉病变冠心病患者,其中69例采用MICS CABG方式治疗(微创组)、78例患者采用传统的开胸手术治疗(传统组);对比两组患者的围手术期指标、手术前后患者血清心肌酶学指标及肾功能指标。对两组患者进行为期2年的随访,记录不良心血管事件(MACE)的发生率,并对其进行生存分析。结果微创组和传统组患者年龄分别为(66.9±5.8)岁和(68.2±7.0)岁,男性比例分别为60.9%(42例)和51.3%(40例)(均P>0.05)。两组患者均顺利完成手术,微创组无患者发生中转开胸手术。术前,微创组和传统组患者的血清肌钙蛋白I(cTnI)、肌酸激酶同工酶(CK-MB)、尿素氮、血清肌酐(Scr)、肌酐清除率差异均无统计学意义(均P>0.05)。术后48 h再次复查,微创组的血清cTnI为(3.109±0.664)μg/L,CK-MB为(18.03±3.27)U/L,均低于传统组的(3.438±0.715)μg/L、(20.63±4.28)U/L,差异均具有统计学意义(均P<0.05)。术后2年随访中,微创组和传统组的再发心肌梗死、心房颤动、脑卒中、心律失常、心力衰竭、血栓形成、心源性死亡、MACE发生率差异均无统计学意义(均P>0.05)。生存曲线分析结果显示,微创组与传统组患者累积MACE事件发生率分别为17.39%和26.92%(P=0.171)。结论MICS CABG对多支冠状动脉病变冠心病患者的效果较好,与传统开胸手术相比其创伤小、术后恢复快,对患者心肌功能恢复具有临床意义。Objective To investigate the clinical efficacy of minimally invasive cardiac surgery coronary artery bypass grafting(MICS CABG)in the treatment of patients with multivessel coronary artery disease.Methods A total of 147 patients with multi-vessel coronary artery disease and coronary heart disease who underwent surgical treatment in Henan Provincial People′s Hospital from March 2016 to March 2019 were retrospectively selected.Of which,69 patients were treated by MICS CABG(minimally invasive group)and 78 patients were treated using the traditional thoracotomy(traditional group).The perioperative indexes,serum myocardial enzyme indexes and renal function indexes of patients before and after operation were compared between the two groups;Two groups of patients were followed up for 2 years;the incidence of adverse cardiovascular events(MACE)was recorded,and survival analysis was performed.Results The age of the patients in the minimally invasive group and the traditional group were(66.9±5.8)and(68.2±7.0)years old,respectively,and the proportions of males were 60.9%(42 cases)and 51.3%(40 cases)(all P>0.05).All patients in the two groups successfully completed the operation,and no patients in the minimally invasive group were converted to thoracotomy.Before surgery,there was no significant difference in serum cTnI,CK-MB,BUN,Scr,and creatinine clearance between the minimally invasive group and the traditional group(all P>0.05).After re-examination 48 hours after operation,the serum cTnI in the minimally invasive group was(3.109±0.664)μg/L,and the CK-MB was(18.03±3.27)U/L,which were lower than those in the traditional group(3.438±0.715)μg/L,(20.63±4.28)U/L;the difference was statistically significant(all P<0.05).During the 2-year follow-up,there was no statiscally significant difference in the incidence of recurrent myocardial infarction,postoperative atrial fibrillation,postoperative stroke,arrhythmia,heart failure,thrombosis,cardiac death,and MACE events between the minimally invasive group and the traditional

关 键 词：冠心病 微创手术 冠状动脉搭桥术 冠状动脉病变 微创冠状动脉旁路移植术 

分 类 号：R541.4[医药卫生—心血管疾病]