比较获取不同乳内动脉行不停搏冠状动脉旁路移植术的早期效果  

To compare the early effects of off-pump coronary artery bypass grafting with different internal mammary arteries

作　　者：房磊 曹向戎[2] 王丕杉 金琪琳 孟祥宽 王坡 FANG Lei;CAO Xiangrong;WANG Pishan;JIN Qilin;MENG Xiangkuan;WANG Po(Department of Cardiac Surgery,Capital Medical University Daxing Teaching Hospital,Beijing 102600;Department of Cardiac Surgery,Beijing Institute of Heart,Lung and Blood Vessel Diseases,Beijing Anzhen Hospital,Capital Medical Unwersity,Beijing 100029,China)

机构地区：[1]首都医科大学大兴教学医院心脏外科,北京102600 [2]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外科,100029

出　　处：《国际心血管病杂志》2024年第3期181-185,共5页International Journal of Cardiovascular Disease

摘　　要：目的:比较骨骼化乳内动脉(IMA)与带蒂IMA行不停搏冠状动脉旁路移植术(OPCABG)后的早期临床效果。方法:选取2020年10月至2022年4月首都医科大学大兴教学医院110例单纯行胸骨正中切口的OPCABG患者,搭桥方式均为左侧IMA与前降支吻合。其中男性81例,女性29例,平均年龄(58.6±8.7)岁。根据术中IMA获取情况,分为骨骼化IMA组(54例)和带蒂IMA组(56例)。比较2组IMA获取时间、住院时间、吻合后血管流速、术后引流量、术后第2天C反应蛋白、胸部切口感染、胸骨哆开等情况。结果:与带蒂IMA组比较,骨骼化IMA组吻合后桥血管流速更快[(73.56±40.16)mL/min对(58.26±33.27)mL/min],获取时间更长[(31.6±7.8)min对(24.3±8.1)min],术后总引流量更少[(428.6±318.7)mL对(541.7±332.5)mL],2组比较差异有统计学意义(P<0.05)。2组术后第2天C反应蛋白、胸部切口感染、胸骨哆开及住院时间等差异无统计学意义。OPCABG后平均随访15个月,2组主要不良心脑血管事件发生率、乳内动脉桥通畅率、大隐静脉桥通畅率的差异无统计学意义。结论:获取骨骼化IMA比带蒂IMA时间长,难度高,但术后桥血管血流更好,动脉桥更长,可序贯弥漫病变前降支,且术后总引流量更少,骨骼化IMA在OPCABG中应用早期疗效满意。Objective:To compare and analyze the application effect of obtaining skeletonized or pedicled internal mammary artery(IMA)in off-pump coronary artery bypass grafting(OPCABG).Methods:110 patients who underwent OPCABG were enrolled in the trialfrom October 2020 to April 2022.Of the 110 participated patients,81 were male,29 were female,with an average age of 58.6±8.7.Patients were divided into skeletonized group(n=54)and pedicled group(n=56)according to the intraoperative IMA acquisition.All patients were harvested LIMAs when they underwent OPCABG from median thoracic incision.LIMAs were anastomosised to the left anterior descending artery.The time of artery acquisition,hospital stay,postoperative flow,postoperative drainage,c-reactive protein(CRP),chest incision infection and sternum dehiscence were compared between the two groups.Results:The blood flow of internal mammary bridge in the skeletonized group was significantly higher than that in the pedicled group(73.56±40.16)mL/min vs.(58.26±33.27)mL/min,P<0.05,and the IMA acquisition time in the skeletonized IMA group was significantly longer than that in the pedicled IMA group(31.6±7.8)min vs.(24.3±8.1)min,P<0.05.The biood flow of IMA in the skeletonized group was better than that in the pedicled group(428.6±318.7)mL vs.(541.7±332.5)mL,(P<0.05).while the c-reactive protein,chest wound infection,sternum dehiscence and hospital stay were not statistically significant.In 15 months of follow-up after surgery.There was no significant difference in MACCE events,patency rate of internal mammary artery bridge and great saphenous vein bridge between the two groups.Conclusion:Compared with obtaining the pedicled internal mammary artery,it is more difficult to obtain the skeletonized IMA.In the skeletonized group,the blood flow of the IMA bridge is better,the skeletonized internal mammary artery bridge is longer,and the anterior descending branch of the lesion can be diffused in sequence,and the skeletonized IMA had less total drainage.The skeletonized IMA has a satisf

关 键 词：冠状动脉旁路移植术 冠状动脉粥样硬化性心脏病 乳内动脉 

分 类 号：R654.2[医药卫生—外科学]