作者：蔡馨，宋宇娟，蔡忠香，肖莹，程志，王志维

单位：

430060 湖北省武汉市，武汉大学人民医院心血管外科 通信作者：蔡忠香，E-mail：841199968@qq.com

Units：

Department of Cardiovascular Surgery, People's Hospital of Wuhan University, Wuhan 430060, China Corresponding author: CAI Zhongxiang, E-mail: 841199968@qq.com

关键词：

冠心病; 冠状动脉旁路移植术; 非体外循环; 体外循环; 心功能; 疗效比较研究;

Keywords：

Coronary disease; Coronary artery bypass grafting; Off-pump circulation; Extracorporeal circulation;Cardiac function; Comparative effectiveness research

CLC：

DOI：

10.12114/j.issn.1008-5971.2021.00.262

Funds：

国家自然科学基金资助项目（82070481）

摘要：

背景冠状动脉旁路移植术是临床治疗冠状动脉病变及心功能不全的有效术式,可在体外循环或非体循环下进行,而体外循环冠状动脉旁路移植术较易造成心肌缺血再灌注损伤、全身炎症反应,导致术后并发症发生风险增高;而非体外循环冠状动脉旁路移植术无需在心脏停搏的前提下进行。目的比较体外与非体外循环冠状动脉旁路移植术治疗冠心病的疗效及其对患者心功能的影响。方法回顾性选取武汉大学人民医院2017年10月至2019年10月收治的冠心病患者100例,按手术方式分为对照组46例和观察组54例。对照组患者采用体外循环冠状动脉旁路移植术治疗,观察组患者采用非体外循环冠状动脉旁路移植术治疗。比较两组患者手术时间、术中出血量、重症监护室入住时间、出院时间、植入支架支数、血管活性药物使用时间、住院费用及术前、术后1 d心功能指标[心脏指数(CI)、左心室做功指数(LVSWI)、右心室做功指数(RVSWI)]。随访1个月,比较两组患者并发症发生率。结果观察组手术时间、重症监护室入住时间、出院时间、血管活性药物使用时间短于对照组,术中出血量、住院费用少于对照组(P <0.05)。两组患者术前CI、LVSWI、RVSWI比较,差异无统计学意义(P> 0.05);术后1 d观察组患者CI、LVSWI、RVSWI高于对照组(P <0.05)。两组患者术后1 d CI分别高于本组术前,LVSWI、RVSWI分别低于本组术前(P <0.05)。观察组患者并发症发生率低于对照组(P <0.05)。结论与体外循环下冠状动脉旁路移植术比较,非体外循环冠状动脉旁路移植术治疗冠心病可有效缩短治疗时间,减少术中出血量及住院费用,对患者心功能的影响较小,且安全性较高。

Abstract：

【Abstract】 Backgroud Coronary artery bypass grafting (CABG) is an effective method for clinical treatment ofcoronary artery disease and cardiac insufficiency, which can be performed under extracorporeal and off-external circulation.CABG under extracorporeal circulation is easy to cause myocardial ischemia-reperfusion injury and systemic inflammatoryreaction, which leads to increased risk of postoperative complications. However, CABG under off-external circulation didn'tneed to be performed under the premise of cardiac arrest.Objective To compare the effect of CABG under extracorporeal andoff-external circulation on treating coronary heart disease and their effect on cardiac function of patients.Methods A totalof 100 patients with coronary heart disease admitted to People's Hospital of Wuhan University from October 2017 to October2019 were retrospectively selected, and they were divided into control group (n=46) and observation group (n=54) according tosurgical methods. Patients in control group were treated with CABG under extracorporeal circulation, and patients in observationgroup were treated with CABG under off-external circulation. Operation time, intraoperative blood loss, admission time in ICU,discharge time, number of implanted stents, time of vasoactive drug therapy, hospitalization expenses, cardiac function indexes[cardiac index (CI) , left ventricular stroke work index (LVSWI) , right ventricular stroke work index (RVSWI) ] before operationand at 1 day after operation were compared between the two groups. The patients were followed up for 1 month, and the incidenceof complications was compared between the two groups. Results Operation time, admission time in ICU, discharge time and timeof vasoactive drug therapy in observation group were shorter than those in control group, intraoperative blood loss, hospitalizationexpenses were less than those in control group (P< 0.05) . There was no significant difference in CI, LVSWI, RVSWI betweenthe two groups before operation (P > 0.05) ; CI, LVSWI and RVSWI in observation group were higher than those in control groupat 1 day after operation (P< 0.05) . In the two groups, CI at 1 day after operation was higher than that before operation, LVSWIand RVSWI were lower than those before operation, respectively (P< 0.05) . Incidence of complications in observation group waslower than that in control group (P < 0.05) . Conclusion Compared with CABG under extracorporeal circulation, CABG underoff-external circulation can effectively shorten treatment time, reduce intraoperative blood loss and hospitalization costs, and withlittle impact on cardiac function and high safety.

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