【摘要】 目的比较体外循环下冠状动脉旁路移植术(ONCAB)和非体外循环下冠状动脉旁路移植术(OPCAB)的围术期效果及远期预后。方法选取1998年11月—2009年12月在广东省中医院大学城医院心血管二科行单纯ONCAB的患者97例,为ONCAB组;另选取同期在本科行单纯OPCAB的患者150例,为OPCAB组。收集并比较两组患者的基线资料、围术期资料及随访资料。结果 OPCAB组患者年龄高于ONCAB组,左主干病变发生率低于ONCAB组,差异有统计学意义(P<0.05)。OPCAB组患者远端吻合口数少于ONCAB组,手术时间及术后机械通气时间、入住ICU时间、住院时间短于ONCAB组,术后多巴胺用量、红细胞用量、血浆用量及术后引流量少于ONCAB组,差异有统计学意义(P<0.05)。两组患者住院死亡率比较,差异无统计学意义(P>0.05)。围术期存活的242例患者中,172例(71.1%)随访7年以上,平均随访时间为(11.6±2.5)年。OPCAB组随访7年以上患者胸闷/心绞痛症状发生率、新发ST-T改变/心律失常率、血管桥闭塞发生率高于ONCAB组,差异有统计学意义(P<0.05);但二者因心脏事件死亡率、因心脏外事件死亡率及总死亡率比较,差异无统计学意义(P>0.05)。结论 OPCAB的围术期康复效果明显优于ONCAB;但OPCAB因操作较困难导致远期桥血管通畅率较差,再发胸闷/心绞痛率、新发心肌缺血性改变率较高。更多还原

【Abstract】 Objective To compare the perioperative effect and long-term outcome of on-pump coronary artery bypass( ONCAB) with those of off-pump coronary artery bypass( OPCAB). Methods We obtained and compared the baseline data, perioperative data and follow-up data of 97 cases undergoing ONCAB( ONCAB group), and 150 cases undergoing OPCAB( OPCAB group) in No. 2 Cardiovascular Department,Daxuecheng Branch Hospital,Guangdong Provincial Hospital of TCM from November 1998 to December 2009. Results Compared with the patients in the ONCAB group,those in the OPCAB group were older,and they had lower incidence of left main coronary artery lesions( P < 0. 05). Patients in the OPCAB group had less number of distal anastomosis,shorter duration of operation,shorter duration of mechanical ventilation,shorter length of stay in the ICU and shorter length of stay,and they used less dopamine,transfused less red blood cells and plasma postoperatively,as well as had less amount of postoperative drainage compared with those in the ONCAB group( P < 0. 05).Two groups had no significant difference in the hospital mortality( P > 0. 05). Of the 242 cases who survived during the perioperative period,71. 1%( 172) were followed up for over seven years,with a mean follow-up period of( 11. 6 ± 2. 5)years. Chest tightness/angina pectoris,ST-T wave changes/arrhythmia,graft occlusion were more likely to occur in patients with follow-up period of over seven years in OPCAB group than those in the ONCAB group( P < 0. 05),but the mortality rates related to cardiac events and non-cardiac events,and overall mortality were similar in both groups( P > 0. 05). Conclusion Patients in the OPCAB group have much better surgical effect, but they have lower long-term patency rate due to more complicated techniques required by OPCAB,and higher recurrence of chest tightness/angina pectoris and incidence of myocardial ischemic changes.更多还原