微创与常规不停跳冠状动脉旁路移植术治疗冠心病的效果比较  

Comparison of therapeutic effect of minimally invasive versus conventional off-pump coronary artery bypass grafting on coronary heart disease

作　　者：孙鹏飞 Sun Pengfei(Department of Cardiac Vascular Surgery,Shanxi Yingkang Yisheng General Hospital,Yuncheng 044000,China)

机构地区：[1]山西盈康一生总医院心脏大血管外科,运城044000

出　　处：《中国实用医刊》2023年第6期27-30,共4页Chinese Journal of Practical Medicine

基　　金：山西省卫生健康委员会科技攻关项目(2020164)。

摘　　要：目的探讨冠心病(CHD)患者采取微创或常规不停跳冠状动脉旁路移植术(OPCABG)治疗的临床效果。方法抽取2019年6月至2022年6月山西盈康一生总医院收治的CHD患者458例,根据治疗方案分为观察组(18例)和对照组(440例)。观察组采用微创OPCABG治疗,对照组采用常规OPCABG治疗。比较两组手术相关指标,术前与术后1个月心功能[左室射血分数(LVEF)、左室舒张末期内径(LVEDD)],术前及术后1、3 d心肌标记物[肌钙蛋白Ⅰ(cTnI)、肌酸激酶同工酶(CKMB)]水平,比较两组并发症发生情况。结果观察组手术时间长于对照组,住院时间及手术出血量少于对照组(P<0.05),两组ICU滞留时间、呼吸机应用时间、引流置管时间、住院时间、胸腔引流量、血管桥数比较差异未见统计学意义(P>0.05)。术前,两组心功能指标比较差异未见统计学意义(P>0.05);术后1个月,观察组LVEF高于对照组,LVEDD低于对照组(P<0.05)。术前,两组心肌标记物水平比较差异未见统计学意义(P>0.05);术后1、3 d,观察组cTnI、CKMB均低于对照组(P均<0.05)。观察组并发症发生情况(1/18)与对照组(49/440)比较差异未见统计学意义(P>0.05)。结论与常规OPCABG治疗比较,CHD采取微创OPCABG治疗虽会延长手术时间,但可缩短住院时间,减少手术出血量,改善患者心功能及心肌标记物水平。Objective To investigate the clinical effect of minimally invasive and conventional off-pump coronary artery bypass grafting(OPCABG)in the treatment of coronary heart disease(CHD).Methods A total of 458 patients with CHD admitted to Shanxi Yingkang Yisheng General Hospital from June 2019 to June 2022 were selected.The patients were divided into observation group(18 cases)and control group(440 cases)according to the treatment schemes.Patients in the observation group were treated by minimally invasive OPCABG,while patients in the control group were treated by conventional OPCABG.The operation-related indexes,cardiac function indexes including left ventricular ejection fraction(LVEF)and left ventricular end-diastolic diameter(LVEDD)before and 1 month after operation,levels of myocardial markers including cardiac troponin I(cTnI)and creatine kinase isoenzyme(CKMB)before operation,1 and 3 days after operation were compared between the two groups.And the incidence of complications of the two groups were compared.Results The operation time of the observation group was longer than that of the control group,while the hospital stay and the operation bleeding volume were less than those of the control group(P<0.05);there was no statistically significant difference in the intensive care unit residence time,ventilator application time,drainage intubation time,hospital stay,thoracic drainage flow,and number of vascular bypass between the two groups(P>0.05).Before operation,there was no significant difference in cardiac function indexes between the two groups(P>0.05).One month after operation,LVEF in the observation group was higher than that in the control group,and LVEDD was lower than that in the control group(P<0.05).There was no significant difference in levels of myocardial markers between the two groups before operation(P>0.05);levels of cTnI and CKMB in the observation group were lower than those in the control group 1 and 3 days after operation(allP<0.05).There was no statistically significant difference in the incide

关 键 词：冠心病 不停跳冠状动脉旁路移植术 微创方案 常规方案 心功能 

分 类 号：R654.2[医药卫生—外科学]