【摘要】 目的评价高风险患者非体外循环冠状动脉旁路移植术(off-pump coronary artery bypass grafting,OPCAB)的安全性、效果及术式的选择。方法回顾分析2002年6月~2005年12月OPCAB术的临床资料,根据欧洲心脏手术风险评分模型(European system for cardiac operative risk evaluation,EuroSCORE)计算每一病例的风险分数,>5分者作为高风险病例进入本研究,共113例,以同期行体外循环冠状动脉旁路移植(cardiopulmonary bypass coronary artery bypass grafting,CCAB)的76例高风险患者作为对照。分别统计两组的手术前风险因素,并对手术中情况、手术后结果进行统计分析对比。结果两组EuroSORE分别为9.0±2.6和8.3±2.1(t=2.016,P=0.045)。移植血管数OPCAB组(3.2±0.9)少于CCAB组(3.8±0.9)(t=-4.267,P=0.000)。术后肌酸激酶、肌酸激酶同功酶OPCAB组[570(61~8246)U/L、20(1~282)U/L]显著低于CCAB组[870(246~8155)U/L、55(12~300)U/L](Z=-3.648、-5.767,P=0.000)。输血量OPCAB组显著少于CCAB组[(775±693)ml vs(1088±712)ml,t=-2.887,P=0.004]。术后并发症差异无显著性。死亡率OPCAB组3.5%(4/113),CCAB组6.6%(5/76),差异无显著性(χ2=0.925,P=0.336)。结论对于高风险病人采纳OPCAB的方法是安全的,临床效果满意。但对于有不同风险因素的病人应采用不同的手术方法。更多还原

【Abstract】 Objective To evaluate the safety,effect,and operation method selection of off-pump coronary artery bypass(OPCAB) in high-risk patients.Methods Clinical records of patients undergoing coronary artery bypass surgery at this department between June 2002 to December 2005 were reviewed.There were 113 patients(OPCAB Group) with a higher(>5) EuroSCORE(European system for cardiac operative risk evaluation) risk of death. Another group of 76 high-risk patients(EuroSCORE > 5) receiving cardiopulmonary coronary artery bypass grafting(CCAB) during the same period was reviewed as control group(CCAB Group).The preoperative risk factors,operation parameters,and postoperative outcomes between the two groups were compared for statistical analysis.Results The EuroSCORE value of the OPCAB Group and the CCAB Group was 9.0±2.6 and 8.3±2.1,respectively(t=2.016,P=0.045). The number of grafts in the OPCAB Group was less than that in the CCAB Group(3.2±0.9 vs 3.8±0.9;t=-4.267,P=0.000).The postoperative levels of creatine kinase(CK) and creatine kinase myocardial band(CK-MB) were significantly lower in the OPCAB Group [570(61～8246) U/L and 20(1～282) U/L] than the CCAB Group [870(246～8155) U/L and 55(12～300) U/L](Z=-3.648 and-5.767,P=0.000).The blood transfusion in the OPCAB Group was significantly less than that in the CCAB Group(775±693 ml vs 1088±712 ml;t=-2.887,P=0.004).There was no statistical difference in postoperative complications between the two groups.The mortality is 3.5%(4/113) in the OPCAB Group and 6.6%(5/76) in the CCAB Group,without statistical difference(χ2=0.925,P=0.336).Conclusions OPCAB is safe and effective in high risk patients.Different operation methods should be used for patients with different risks.更多还原