两种施术方式下冠脉搭桥手术效果的比较(1)
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【摘要】冠脉动脉旁路移植术是治疗冠状动脉硬化性心脏病，特别是多支病变患者的一种非常有效的手段，对延长患者生存时间，提高术后生活质量有肯定的效果。在体外循环下进行冠脉搭桥术被认为是心脏外科进行心肌再血管化的标准手术，但随着对体外循环相关并发症的认识，在非体外循环下实施冠脉搭桥术逐渐受到重视。目前临床上对两种方法的选择存在争议[1—3]。如何选择最恰当的方法行冠脉搭桥术，既可以使再血管化的效果肯定，又尽可能减少手术给患者带来的风险成为心血管外科研究的热点。本文回顾性的总结两种术式围术期的情况，并加以探讨和初步评价。
Coronary artery bypass graft is a medical treatment for coronary heart disease, especially effective for the patients with multivessel disease. It brings a very positive effect on the extension of survival time and the improvement of life quality after postoperative. Coronary artery bypass graft, a cardiac surgery for revascularization, is considered as a standard surgery under the condition of CPB. However based on the knowledge of CPB-related complications, people attach growing importance to the implement of coronary artery bypass graft in the environment of off-bump. Currently there are clinical controversies between the two curing accesses. So how to choose the most appropriate approach to conduct coronary artery bypass graft, which not only can confirm the effect of revascularization, but can minimize the risks of surgery for patients, becomes a central issue for cardiovascular surgery research. The paper retrospectively summarizes the two kinds of surgical situation during perioerative period, giving further discussion and preliminary evaluation of it.
1对象与方法
1.1一般资料
OPCAB组87例，男59例，女28例；平均年龄(62.1±1.7)岁；术前平均左室射血分数(LVEF)为(56.1±11.7)，左径直径(4.76±0.57)mm，合并高血压47例，糖尿病26例，陈旧性心肌梗死32例，脑血管事件19例，肾功能不全15例，慢性阻塞性肺病9例。CABG组75例，男51例，女24例；平均年龄(53.9±3.8)岁。术前平均LVEF(66.1±9.7)，左径直径(5.03土0.82)mm，合并高血压41例，糖尿病33例，陈旧性心肌梗死29例，脑血管事件7例，肾功能不全3例，慢性阻塞性肺病6例。
表1两组患者术前一般情况对比
类别OPCAB组(n=87)CPB组(n＝75)
男性(例)59(67.8%)51(68.0%)
女性(例)28(32.2%)24(42.1%)
平均年龄(岁)62.1±1.753.9±3.8
心梗史(例)32(36.7%)29(38.7%)
术前LVEF(%)56.1±11.766.1±9.7
左径直径(mm)4.76±0.575.03±0.82
肾功能不全史(例)15(17.2%)5(6.6%)
脑血管事件19例(21.8%)7例(9.3%)
慢性阻塞性肺病9例(10.3%)6例(8.0%)
糖尿病37例(42.5%)23例(30.6%)
1.2手术方法
全部患者采用正中开胸。OPCAB组OPCAB先取左内乳动脉或大隐静脉与左前降支吻合，以改善左心血供，然后用大隐静脉吻合或作序贯式吻合右冠状动脉桥及左冠状动脉回旋支。心脏固定采用Medt ronic或ATS固定器，吻合口采用分流拴或钝头针弹力线控制出血。术中缝合心包悬吊心脏，以吸引式心脏固定器以及CTS或0ctopusII心脏固定器固定心脏 ......
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