【摘要】：目的探討擇期"分站式"冠狀動(dòng)脈血運(yùn)雜交重建(hybrid coronary revascularization,HCR)治療冠狀動(dòng)脈多支血管病變的安全性、可行性。方法選取2012年5月~2014年8月在我院行擇期"分站式"冠狀動(dòng)脈血運(yùn)雜交重建的73例資料,以同期、同一術(shù)者完成的擇期非體外循環(huán)冠狀動(dòng)脈旁路移植術(shù)(off-pump coronary artery bypass,OPCAB)383例作為對(duì)照,進(jìn)行回顧性研究。2組一般資料差異無(wú)顯著性。比較2組圍術(shù)期及隨訪結(jié)果。結(jié)果與OPCAB組相比,HCR組手術(shù)時(shí)間短[(152.9±43.8)min vs.(262.6±51.8)min,t=-16.993,P=0.000],術(shù)后總引流量少[中位數(shù)460(20~2070)ml vs.980(130~8770)ml,Z=-8.232,P=0.000],輸血少[12例(16.4%)vs.200例(52.2%),χ2=31.555,P=0.000],機(jī)械通氣時(shí)間短[(9.4±7.4)h vs.(19.0±18.3)h,t=-4.391,P=0.000]。術(shù)后HCR組隨訪73例(100%),OPCAB組隨訪360例(94.0%)。2組隨訪時(shí)間差異無(wú)顯著性[(25.0±9.6)月vs.(22.8±10.6)月,t=1.693,P=0.091]。2組主要心腦血管不良事件(major adverse cardiac or cerebrovascular events,MACCE)發(fā)生率無(wú)顯著性差異[4例(5.5%)vs.10例(2.8%),χ~2=0.684,P=0.408],生存曲線也無(wú)顯著性差異(log-rankχ~2=1.041,P=0.308)。結(jié)論 "分站式"冠狀動(dòng)脈血運(yùn)雜交重建術(shù)與OPCAB相比手術(shù)時(shí)間短,引流量少,輸血少,機(jī)械通氣時(shí)間短,隨訪結(jié)果顯示其MACCE發(fā)生率與OPCAB相近。因此認(rèn)為,"分站式"冠狀動(dòng)脈血運(yùn)雜交重建術(shù)是一種安全、有效的手術(shù)方式。
[Abstract]:Objective to investigate the safety and feasibility of selective "sub-station" coronary artery hybridization reconstruction (hybrid coronary revascularization,HCR) in the treatment of coronary artery disease. Methods from May 2012 to August 2014, 73 patients underwent selective "sub-station" coronary artery revascularization in our hospital. The patients underwent elective off-pump coronary artery bypass grafting (off-pump coronary artery bypass,) during the same period. A retrospective study was conducted in 383 cases of OPCAB. There was no significant difference in general data between the two groups. The perioperative and follow-up results were compared between the two groups. Results compared with OPCAB group, HCR group had shorter operation time [(152.9 鹵43.8) min vs. () 262.6 鹵51.8 min,t=-16.993,P=0.000] and less total postoperative drainage [median of 460 (20 鹵2070) ml vs.980 (130 鹵8770) ml,Z=-8.232,]. There were 12 cases (16.4%) with vs.200 (52.2%), with short mechanical ventilation time (9.4 鹵7.4) h vs. (19.0 鹵18.3), with short mechanical ventilation time (9.4 鹵7.4) h vs. (19.0 鹵18.3). 73 cases (100%), OPCAB) were followed up in the HCR group (94.0%). There was no significant difference in the follow-up time between the two groups [(25.0 鹵9.6) months vs. (22.8 鹵10.6) months, t = 1.693. There was no significant difference in the incidence of major cardiovascular and cerebrovascular adverse events (major adverse cardiac or cerebrovascular events,MACCE) between the two groups (4 cases (5.5%), vs.10 cases (2.8%), 蠂 ~ 2 + 0.684%, P < 0.408), and there was no significant difference between the two groups in the incidence of major cardiovascular and cerebrovascular adverse events. There was also no significant difference in survival curve (log-rank 蠂 ~ 2 ~ (1.041) P ~ (0.308). Conclusion compared with OPCAB, the "sub-station" coronary artery revascularization has shorter operation time, less drainage, less blood transfusion and shorter mechanical ventilation time. The follow-up results show that the incidence of MACCE is similar to that of OPCAB. It is considered that the branch-by-station coronary artery hybrid reconstruction is a safe and effective method.
【作者單位】： 北京大學(xué)第三醫(yī)院心臟外科;北京大學(xué)第三醫(yī)院心臟內(nèi)科;
【分類號(hào)】：R654.2

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本文編號(hào)：2305842