体外循环与非体外循环下双侧乳内动脉冠状动脉旁路移植术早期预后分析  

Early Outcome Comparison Between On-pump Versus Off-pump Bilateral Internal Mammary Artery Grafting

作　　者：韩增强[1] 王璇 刘刚[1] 陈彧[1] HAN Zengqiang;WANG Xuan;LIU Gang;CHEN Yu(Cardiac Surgery Department,Peking University People's Hospital,Beijing(100044),China)

机构地区：[1]北京大学人民医院心脏外科,北京市100044

出　　处：《中国循环杂志》2022年第10期1033-1036,共4页Chinese Circulation Journal

摘　　要：目的:分析使用体外循环与非体外循环下应用双侧乳内动脉冠状动脉旁路移植术(CABG)后早期效果。方法:回顾性分析2018年1月至2020年12月我科使用双侧乳内动脉行CABG的82例患者临床资料,其中男75例、女7例,平均年龄(56.9±9.8)岁。按照手术方式分为非体外循环下CABG组(OPCAB组,55例)和体外循环下CABG组(CCABG组,27例)。比较两组患者围术期的临床情况,出院前行冠状动脉CT检查评价桥血管通畅情况。结果:围术期死亡1例(1.22%)。轻微胸骨切口并发症3例(3.66%),无胸骨松动,换药并重新缝合后治愈。与CCABG组比较,OPCAB组围术期输红细胞及平均远端吻合口数少,平均手术时间短。两组乳内桥血管平均流量、搏动指数、舒张期充盈百分比差异均无统计学意义(P>0.05)。两组手术时间/远端吻合口数、围术期心肌梗死及脑卒中发生率等差异均无统计学意义(P>0.05)。出院前复查冠状动脉CT,仅OPCAB组有1例右乳内动脉到右冠状动脉桥血管闭塞。结论:体外循环与非体外循环下使用双侧乳内动脉行CABG,桥血管早期通畅性相近,双侧乳内动脉是稳定理想的冠状动脉旁路移植物。Objectives:To analyze the early operative results of application of bilateral internal mammary artery(BIMA)in onpump(CCABG)and off-pump(OPCAB)coronary artery bypass grafting(CABG).Methods:From January 2018 to December 2020,82 patients(75 males,7 females,aged 56.9±9.8 years)underwent CABG using BIMA with either on-pump(CCABG group,n=27)or off-pump(OPCAB group,n=55)strategies.The perioperative outcomes of the two groups were compared.The CT angiography of coronary artery was performed to evaluate the grafts patency before discharge.Results:There was 1(1.22%)early operative death.3(3.66%)patients suffered from mild sternal wound complication without sterna instability and then healed after dressing and a secondary suturing.Blood transfusion was less in OPCAB group.There was no statistical difference in the graft blood flow,the ratio of operative time to the number of distal anastomoses,incidence of perioperative myocardial infarction and cerebral infarction between the two groups.CT angiography before discharge showed right internal mammary artery graft to right coronary artery occlusion in one patient in OPCAB group.Conclusions:No significant difference exists in the graft patency between OPCAB and CCABG groups in early stage.BIMA are ideal and stable coronary bypass grafts.

关 键 词：冠状动脉旁路移植术 非体外循环 乳内动脉 瞬时血流测定 

分 类 号：R541.4[医药卫生—心血管疾病]