2023 年第 5 期 第 18 卷

非体外循环和体外循环冠状动脉旁路移植术在高危冠状动脉疾病患者中的应用效果比较

Comparison of the application effect of off-pump and on-pump coronary artery bypass grafting in patients with high-risk coronary artery disease

作者：于洋林多茂马骏

英文作者：Yu Yang Lin Duomao Ma Jun

单位：首都医科大学附属北京安贞医院麻醉中心，北京100029

英文单位：Anesthesia Center Beijing Anzhen Hospital Capital Medical University Beijing 100029 China

关键词：冠状动脉疾病；冠状动脉旁路移植术；非体外循环；体外循环

英文关键词：Coronaryarterydisease;Coronaryarterybypassgrafting;Off-pump;On-pump

• 摘要：

• 目的 比较非体外循环和体外循环冠状动脉旁路移植术（CABG）在高危冠状动脉疾病患者中的应用效果。方法 收集2012年1月至2014年12月在首都医科大学附属北京安贞医院行CABG的105例高危冠状动脉疾病患者的病历资料进行回顾性分析。根据手术技术方法的不同分为非体外循环组（47例）和体外循环组（58例）。比较2组术前基本资料、术中及术后参数、术后30 d内并发症发生情况及结局指标。结果  非体外循环组患者年龄大于体外循环组，左心室射血分数低于体外循环组，欧洲心脏手术风险评估系统评分和90 d内心肌梗死比例高于体外循环组，差异均有统计学意义（均P<0.05）。非体外循环组患者移植物数量、冠状动脉内膜剥脱术比例、机械通气时间、输注浓缩红细胞比例少于/低于/短于体外循环组，差异均有统计学意义（均P<0.05）。体外循环组与非体外循环组术后30 d内心房颤动、出血、低心排血量综合征等并发症发生率差异均无统计学意义（均P>0.05），术后30 d内心肌梗死和死亡率差异均无统计学意义［6.9%（4/58）比4.3%（2/47）、3.4%（2/58）比2.1%（1/47）］（均P>0.05）。结论   在高危冠状动脉疾病患者中非体外循环CABG在术后30 d内并发症发生情况及结局指标方面并不具有显著的临床优势。

• Objective  To compare the application effect of off-pump and on-pump coronary artery bypass grafting(CABG) in patients with high-risk coronary artery disease. Methods From January 2012 to December 2014, the medical records of 105 patients with high-risk coronary artery disease who underwent CABG in Beijing Anzhen Hospital, Capital Medical University were collected and analyzed retrospectively. They were divided into off-pump group(47 cases) and on-pump group(58 cases) according to different surgical techniques and Methods . The basic preoperative data, intraoperative and postoperative parameters, complications and outcome indicators within 30 d after surgery were compared between the two groups. ResultsPatients in the off-pump group were older than those in the on-pump group, and their left ventricular ejection fractions were lower than those in the on-pump group. The scores of the European Heart Surgery Risk Assessment System and the proportion of myocardial infarction within 90 d were higher than those in the on-pump group (all P<0.05). The number of grafts, the proportion of coronary endarterectomy, the time of mechanical ventilation, and the proportion of concentrated red blood cells infused in the off-pump group were less/lower/shorter than those in the on-pump group (all P<0.05). There were no statistically significant differences in the incidences of complications such as atrial fibrillation, bleeding, and low cardiac output syndrome between the on-pump group and the off-pump group within 30 d after surgery (all P>0.05). There were no statistically significant differences in the incidences of myocardial infarction and mortality within 30 d after surgery［6.9%(4/58) vs 4.3%(2/47), 3.4%(2/58) vs 2.1%(1/47)］(both P>0.05). Conclusion In patients with high-risk coronary artery disease, off pump CABG does not have significant clinical advantages in terms of complications and outcome indicators within 30 d after surgery.