【摘要】：目的:對(duì)比分析研究分期雜交技術(shù)(staged-hybrid coronary revascularization,Staged-HCR)與微創(chuàng)雙側(cè)胸廓內(nèi)動(dòng)脈(bilateral internal thoracic artery,BITA)全動(dòng)脈旁路移植術(shù)治療多支冠狀動(dòng)脈病變的安全性和有效性。方法:自2014年8月至2017年2月,70名患者接受微創(chuàng)冠狀動(dòng)脈旁路移植術(shù)治療多支冠狀動(dòng)脈血管病變,隨機(jī)分為兩組,其中應(yīng)用微創(chuàng)直視冠狀動(dòng)脈旁路移植技術(shù)(minimally invasive direct coronary artery bypass grafting,MIDCAB)行左側(cè)胸廓內(nèi)動(dòng)脈至冠狀動(dòng)脈前降支搭橋、結(jié)合經(jīng)皮冠狀動(dòng)脈介入技術(shù)(percutaneous coronary intervention,PCI)治療非前降支血管病變的Staged-HCR組患者40名;應(yīng)用微創(chuàng)BITA旁路移植術(shù)治療患者30名。對(duì)比兩組患者的術(shù)前資料、術(shù)中血液制品使用情況、機(jī)械通氣時(shí)間、監(jiān)護(hù)室停留時(shí)間、術(shù)后主要心腦血管不良事件以及術(shù)后冠狀動(dòng)脈造影結(jié)果,分析兩種微創(chuàng)方法治療冠狀動(dòng)脈多支血管病變的安全性和有效性。結(jié)果:兩組患者術(shù)前資料差異無統(tǒng)計(jì)學(xué)意義,均按計(jì)劃接受微創(chuàng)搭橋治療。在術(shù)后機(jī)械輔助通氣時(shí)間[Staged-HCR組(11.2±8.7)h,微創(chuàng)BITA組(18.3±9.1)h,P=0.013]、監(jiān)護(hù)室停留時(shí)間[Staged-HCR組(26.29±4.05)h,微創(chuàng)BITA組(44.74±28.75)h,P=0.022]以及累計(jì)傷口引流量[Staged-HCR組(695.57±250.46)m L,微創(chuàng)BITA組(1103.26±547.44)m L,P=0.03]方面,Staged-HCR技術(shù)更有優(yōu)勢。術(shù)后冠狀動(dòng)脈造影顯示兩種方法均取得較高的移植血管通暢率,兩組患者住院期間未發(fā)生術(shù)后主要心腦血管不良事件。結(jié)論:Staged-HCR技術(shù)是治療冠狀動(dòng)脈多支病變的一種微創(chuàng)方法,在治療存在右冠狀動(dòng)脈主干病變再血管化方面有優(yōu)勢;微創(chuàng)BITA全動(dòng)脈化旁路移植手術(shù)具備更優(yōu)異的遠(yuǎn)期通暢率,且適用于不能耐受PCI治療后雙聯(lián)抗血小板治療的患者,本研究表明兩種方法均安全且有效。
[Abstract]:Objective: to compare the safety and efficacy of staging crossbreeding (staged-hybrid coronary revascularization,Staged-HCR) and minimally invasive bilateral internal thoracic artery (bilateral internal thoracic artery,BITA) bypass grafting in the treatment of multi-vessel coronary artery disease. Methods: from August 2014 to February 2017, 70 patients underwent minimally invasive coronary artery bypass grafting for multi-vessel coronary artery disease and were randomly divided into two groups. Minimally invasive direct coronary artery bypass grafting (minimally invasive direct coronary artery bypass grafting,MIDCAB) was performed between the left internal thoracic artery and the anterior descending coronary artery, combined with percutaneous coronary intervention (percutaneous coronary intervention,). PCI) 40 patients in Staged-HCR group who were treated with non-anterior descending artery disease. 30 patients were treated with minimally invasive BITA bypass grafting. The preoperative data, the use of blood products during operation, the time of mechanical ventilation, the residence time of monitor room, the main cardiovascular and cerebrovascular adverse events after operation and the results of coronary angiography were compared between the two groups. To analyze the safety and effectiveness of two minimally invasive methods in the treatment of coronary artery multi-vessel disease. Results: there was no significant difference in preoperative data between the two groups. All patients were treated with minimally invasive bypass according to the plan. The postoperative mechanical ventilation time [Staged-HCR group (11.2 鹵8.7) h, minimally invasive BITA group (18.3 鹵9.1) h, P 鈮，

本文編號(hào)：2486117