多动脉非体外循环冠状动脉旁路移植早中期疗效  

Early and mid-term outcomes of multiartery off-pump coronary artery bypass grafting

作　　者：张仁腾 姜辉 陶登顺 徐殊 祝岩 Zhang Renteng;Jiang Hui;Tao Dengshun;Xu Shu;Zhu Yan(Department of Cardiovascular Surgery,General Hospital of Northern Theater Command,Liaoning Shenyang 110016,China)

机构地区：[1]北部战区总医院心血管外科,沈阳110016

出　　处：《中国体外循环杂志》2023年第2期103-106,共4页Chinese Journal of Extracorporeal Circulation

摘　　要：目的 倾向性评分匹配法(PSM)评估多动脉非体外循环冠状动脉旁路移植(OPCABG)早期及中期治疗效果。方法 回顾2017年2月至2017年12月,74例多动脉OPCABG患者(MA组)及同期158例常规OPCABG患者(SA组)临床资料。采用PSM 1∶1匹配,得到术前基础数据均衡的样本两组各69例。分析比较匹配后两组术后早期、中期主要心脑血管事件(MACCE)比例及纽约心脏病学会(NYHA)心功能分级。结果 匹配前MA组年龄、女性比例、体质量指数明显低于SA组;匹配后两组各项基础指标无明显差异。手术时间MA组明显高于SA组,两组围术期(术后30天)其他临床指标无明显差异。中位随访时间3.8年(最高5.1年)。术后早期(1年),两组MACCE比例(P=0.515)及NYHA心功能分级(P=0.706)无明显差异。术后中期MACCE比例,两组比较无明显统计学差异(P=0.170);NYHA心功能分级MA组明显优于SA组(P=0.040)。结论 多动脉再血管化用于OPCABG不增加围术期心血管风险、胸骨愈合不良和呼吸系统并发症,并可能有助于维护术后中期心脏功能。Objective To investigate the early and mid-term therapeutic efficacy of multiartery off-pump coronary artery by⁃pass grafting(OPCABG)using propensity score matching.Methods We reviewed the clinical data of 74 patients with multiarterial OPCABG(MA group)and 158 patients with conventional OPCABG(SA group)in our hospital from February 2017 to December 2017.According to PSM's nearest neighbor matching method,the two groups were matched 1:1,and 69 cases in each group were ob⁃tained.The proportion of major cardiovascular and cerebrovascular events(MACCE)and cardiac function status in the early and mid⁃dle postoperative period were analyzed and compared between the matched two groups.Results Before matching,age,female propor⁃tion and body mass index(BMI)in MA group were significantly lower than those in SA group.There was no significant difference in basic indexes between the two groups after matching.The operation time of MA group was significantly longer than that of SA group,and there was no significant difference in other perioperative clinical indicators between the two groups.Median follow-up time was 3.8 years(maximum 5.1 years).In the early postoperative period(1 year),there was no significant difference in the proportion of MACCE(P=0.515),or in the NYHA class(P=0.706).In middle postoperative period,there was no significant difference in the proportion of MACCE(5.9%vs.8.8%,P=0.170).The cardiac function of the former was obviously better than that of the latter(NYHAⅠ:65.2%vs.43.1%;NYHAⅡ:24.2%vs.38.5%;NYHAⅢ,Ⅳand death:10.6%vs.18.5%;P=0.040).Conclusion Multiarterial revascularization with OPCABG didn't increase perioperative cardiovascular risk and sternal malunion and respiratory complications,and might be helpful to maintain mid-term cardiac function after operation.

关 键 词：体外循环 冠状动脉旁路移植术 多动脉再血管化 乳内动脉 桡动脉 完全再血管化 

分 类 号：R654.2[医药卫生—外科学]