不停跳冠状动脉旁路移植术骨骼化与带蒂乳内动脉术后早期疗效研究  

Early postoperative outcomes of skeletonized versus pedicled internal mammary artery in off-pump coronary artery bypass grafting

作　　者：杨耀辰 曹剑[1] 宋跃[1] 刘冬[1] 董然[1] YANG Yaochen;CAO Jian;S ONG Yue;LIU Dong;DONG Ran(Department of Cardiac Surgery,Beijing Anzhen Hospital,Capital Medical University,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart,Lung and Blood Vessel Diseases,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所心脏外科,100029

出　　处：《心肺血管病杂志》2023年第4期333-337,共5页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:研究两种不同乳内动脉(internal mammary artery,IMA)获取方式下患者术中以及术后早期治疗效果的差异。方法:回顾性分析从2021年1月至9月,单纯行不停跳冠状动脉旁路移植术(off-pump coronary artery bypass grafting,OPCABG)的患者97例,其中男性75例,女性22例,平均年龄(59.4±8.4)岁。根据患者术中IMA获取方式分为骨骼化左乳内动脉组(47例)及带蒂LIMA组(50例)。均采用胸部正中切口OPCABG术式,两组IMA取材均为左侧IMA,行LIMA与前降支(LAD)或LIMA与对角支(D)吻合。通过收集对比患者术中、术后住院时基本情况以及出院后1年情况评估两种方式获取乳内动脉的安全性和有效性。结果:骨骼化组术中LIMA桥血管流量高于带蒂组[71(46,97)vs.53.5(41.75,80.75)mL/min,P=0.044],骨骼化IMA组获取LIMA时间长于带蒂IMA组[(30.4±7.6)vs.(23.1±8.2)min,P<0.001],但骨骼化IMA组整体手术时间与带蒂IMA组,差异无统计学意义[(4.8±0.6)vs.(4.8±0.7)h,P>0.05]。骨骼化IMA组患者术后引流量少于带蒂IMA组[420(330,700)vs.560(397.5,797.5)m L,P=0.028]。1年后两组随访患者无心绞痛复发,随访率86.6%(40/44)。结论:骨骼化获取乳内动脉可减少术后患者失血,患者术后早期预后较好,疗效满意,骨骼化乳内动脉的中远期疗效还需要进一步的研究验证。Objective:To study the difference of clinical outcomes between two different methods of internal mammary artery(IMA)harvesting.Methods:A total of 97 patients who underwent off-pump coronary artery bypass grafting(OPCABG)between January 2021 and September were enrolled in this study.Of the 97 participated patients,75 were male,22 were female,with an average age of(59.4±8.4)years.Patients were stratified into skeletonized group(n=47)and pedicled group(n=50)according to their ways of IMA harvesting.All patients were harvested LIMAs when they underwent OPCABG from median thoracic incision.LIMAs were anastomosed the left anterior descending artery and diagonal branch artery.Results:The mean graft flow of internal mammary artery graft in the skeletonized group was significantly higher than that in the pedicled group[71(46,97)vs.53.5(41.75,80.75)mL/min,P=0.044],and the LIMA harvesting time in the skeletonized IMA group was significantly longer than that in the pedicled IMA group[(30.4±7.6)vs.(23.1±8.2)min,P<0.001],whereas the operation time in the skeletonized IMA group was no obviously difference between the pedicled IMA group[(4.8±0.6)vs.(4.8±0.7)h,P>0.05].the postoperative drainage in the skeletonized IMA group was significantly lesser than that in the pedicled IMA group[420(330,700)vs.560(397.5,797.5)mL,P=0.028].Among follow-up patients(follow-up rate 86.6%)after one year,no one had recurrence of angina.Conclusions:The skeletonized IMA significantly reduces postoperative bleeding with preservation of integrity of vessel bed which would benefit patients’recovery.The early postoperative prognosis of patients is good and the efficacy is satisfactory.But the medium and long-term efficacy of LIMA needs further research.

关 键 词：冠状动脉粥样硬化性心脏病 冠状动脉旁路移植术 骨骼化乳内动脉 

分 类 号：R54[医药卫生—心血管疾病]