非体外循环冠状动脉旁路移植术联合内膜剥脱术治疗弥漫性冠状动脉疾病的预后研究  

Short- and long-term prognosis of off-pump coronary endarterectomy

作　　者：刘长城[1] 方颖[1] 韦华[1] 李海洋[1] 顾承雄[1] Liu Changcheng;Fang Ying;Wei Hua;Li Haiyang;Gu Chengxiong(Department of Cardiac Surgery,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院心脏外科,北京100029

出　　处：《中华胸心血管外科杂志》2023年第4期223-227,共5页Chinese Journal of Thoracic and Cardiovascular Surgery

基　　金：北京医院管理局临床医学发展专项基金(XMLX202107)。

摘　　要：目的评估非体外循环冠状动脉旁路移植术(OPCABG)联合冠状动脉内膜剥脱术(CE)治疗弥漫性冠状动脉疾病的预后。方法回顾性分析2012年1月至2014年12月期间就诊于我科的2 496例OPCABG患者的临床资料, 分为OPCABG组和OPCABG+CE组。应用倾向性评分匹配法进行1∶1匹配, 比较两组围手术期预后、远期生存及不良心脑血管事件(MACCE)。结果倾向性评分匹配后共238对患者纳入分析, 每组238例。OPCABG+CE组术后急性心肌梗死(AMI)发生率显著高于OPCABG组(5.04%对1.68%, P=0.042)。平均随访7.3年, OPCABG组和OPCABG+CE组患者的累计生存率(92.44%对88.65%, P=0.159)和远期MACCE发生率(10.92%对15.13%, P=0.173)差异无统计学意义。与OPCABG组比较, OPCABG+CE组患者心绞痛复发率(CCS分Ⅲ-Ⅳ级)显著增加(20.16%对12.60%, P=0.026)。结论 OPCABG+CE术后早期AMI和远期心绞痛复发风险显著增加, 但OPCABG+CE与OPCABG患者的远期生存率和MACCE发生率差异无统计学意义。Objective To evaluate the prognosis of off-pump coronary artery bypass grafting combined(OPCABG)with coronary endarterectomy(CE)treating the diffuse coronary artery disease.Methods From January 2012 to December 2014,the clinical data of 2496 OPCABG patients in our department were retrospectively analyzed,and they were divided into OPCABG group and OPCABG+CE group.After 1∶1 matching via the propensity score matching method,the perioperative prognosis,long-term survival and adverse cardiovascular and cerebrovascular events(MACCE)were compared between the two groups.Results A total of 238 pairs of patients were included after propensity score matching.The incidence of postoperative AMI in the OPCABG+CE group was significantly higher than that in the OPCABG group(5.04%vs.1.68%,P=0.042).With an average follow-up of 7.3 years,there was no significant difference in the cumulative survival rate(92.44%vs.88.65%,P=0.159)and long-term MACCE(10.92%vs.15.13%,P=0.173)between the two groups.Compared with the OPCABG group,the recurrence of angina pectoris(CCS gradeⅢ-Ⅳ)in the OPCABG+CE group increased significantly(20.16%vs.12.60%,P=0.026).Conclusion The risk of early AMI and long-term angina recurrence after OPCABG+CE is significantly increased,but the long-term survival and MACCE of OPCABG+CE and OPCABG are comparable.

关 键 词：弥漫性冠状动脉疾病 冠状动脉内膜剥脱术 冠状动脉分流术 预后 

分 类 号：R654.2[医药卫生—外科学]