我们的网站为什么显示成这样？

可能因为您的浏览器不支持样式，您可以更新您的浏览器到最新版本，以获取对此功能的支持，访问下面的网站，获取关于浏览器的信息：

|本期目录/Table of Contents|

体外循环与非体外循环冠状动脉旁路移植术早期疗效分析(PDF)

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2011年第4期
页码:
487
栏目:
临床研究
出版日期:
2011-08-25

文章信息/Info

Title:
Analysis of early outcomes of on-pump coronary artery bypass grafting and off-pump coronary artery bypass grafting
作者:
李扬; 屈正; 张兆光
首都医科大学附属北京安贞医院心脏外科，北京 100029
Author(s):
LI Yang;  QU Zheng;  ZHANG Zhao-guang
Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
关键词:
冠状动脉旁路移植术; 体外循环; 死亡率; 并发症
Keywords:
coronary artery bypass grafting;  cardiopulmonary bypass;  mortality;  complications
分类号:
R541.4
DOI:
61-1268/R.20110503.1526.017
文献标识码:
A
摘要:
目的:探讨体外循环冠状动脉旁路移植术(CCABG)和非体外循环冠状动脉旁路移植术（OPCABG）早期疗效的差异。方法： 采集自2003年10月~2008年1月我院单纯冠状动脉旁路移植术5325例临床资料，分为CCABG组（343例）与OPCABG组（4 982例）。对两组患者各项术前因素、术中因素、手术死亡率及并发症进行比较。结果： OPCABG组实际手术死亡率（1.7％）明显低于CCABG组（6.7％）,P<0.01；术后二次开胸止血、肾功能不全等并发症的发生率及ICU停留时间、呼吸机辅助时间、术后住院时间都低于CCABG组（P<0.05，P<0.01）。风险调整后CCABG组手术死亡率仍高于OPCABG组6个百分点，术后并发症的发生率均略高于OPCABG组（P<0.05）。结论： CCABG与OPCABG早期临床疗效均令人满意，后者更好一些。
Abstract:
AIM:To analyze the difference of the early outcome between conventional coronary artery bypass grafting (CCABG) and off-pump coronary artery bypass grafting (OPCABG). METHODS: A total of 5325 CABG consecutive cases in our hospital from October 2003 to January 2008 were divided into OPCABG group (n=4 982) and CCABG group (n=343). Early outcomes of all patients were analyzed and risk-adjusted mortality and incidence rates of complications were computed using a predictive equation derived by stepwise logistic regression. RESULTS: The mortality in the OPCABG group (1.7%) was much lower than in CCABG group (6.7%, P<0.01). In OPCABG group, postoperative ventilation time (20±15 vs. 31±31 h, P<0.01), length of stay in intensive care unit (28±26 vs. 48±47 h, P<0.01) and hospitalization time (13±9 vs. 16±11 days, P<0.01) were shorter, and the incidence of complications such as hemostasis (1.6 vs. 6.1%, P<0.01) and renal insufficiency (0.8 vs. 2.6%, P<0.01) was lower. After comorbidity adjustment, the mortality rate in CCABG group remained 6% higher than in OPCABG group, and the rate of complications in CCABG group was slightly higher compared with that in OPCABG group. CONCLUSION: Compared with CCABG, OPCABG achieves better early outcome but the medium- and long-term results need to be further followed up.

参考文献/References

[1]Cleveland JC Jr,Shroyer AL,Chen AY,et al.Off-pump coronary artery bypass grafting decrease risk-ajusted mortality and morbidity[J].Ann Thorac Surg,2001,72(4):1282-1289.
[2]Puskas JD,Williams WH,Duke PG,et al.Off-pump coronary artery bypass grafting provide complete revascularization with reduced myocardial injury, transfusion requirement, and length of stay: a prospective randomized comparison of two hurdend unselected patients undergoing off-pump versus conventional coronary artery bypass grafting[J].J Thorac Cardiovasc Surg,2003,125(4):797-808.
[3]Al-Ruzzeh S,Nakamura K,Athanasiou T,et al.Does off-pump coronary artery bypass(OPCABG) surgery improve the outcomes in high-risk patients?:a comparative study of 1398 high-risk patients[J].Eur J Cardiothorac Surg,2003,23(1):50-55.
[4]Chamberlain MH,Ascione R,Reeves BC,et al.Evaluation of the effectiveness of off-pump coronary artery bypass grafting in high-risk patients:an observational study[J].Ann Thorac Surg,2003,73(6)1866-1873.
[5]Sedrakyan A, Wu AW,Parashar A,et al.Off-pump surgery is associated with reduced occurrence of stroke and other morbidity as compared with traditional coronary artery bypass grafting: a meta-analysis of systematically reviewed trials[J].Stroke,2006,37(11):2759-2769.
[6]Buffolo E,de Andrade CS,Branco JN,et al.Coronary artery bypass grafting without cardiopulmonary bypass[J].Ann Thorac Surg,1996,61(1):63-66.
[7]Kshettry VR,Flavin TF,Emery RW,et al.Does multivessel,off-pump coronary artery bypass reduce postoperative morbidity?[J].Ann Thorac Surg,2000,69(6):1725-1730.
[8]Lee JD,Dang CR,Taoka S,et al.Coronary artery bypass grafting performed with or without a bypass pump:early results[J].Hawaii Med J,2000,59(2):54-56.
[9]Arom KV, Emery RW,Flavin TF,et al.Cost effectiveness of minimally invasive coronary artery bypass surgery[J].Ann Thorac Surg,1999,68(4):1562-1566.
[10]Boyd WD,Desai ND,Del Rizzo DF,et al.Off-pump surgery decreases postoperative complications and resource utilization in the elderly[J].Ann Thorac Surg, 1999,68(4):1490-1493.
[11]Reichenspurner H,Boehm D,Detter C,et al.Economic evaluation of different minimally invasive procedures for the treatment of coronary artery disease[J].Eur J Cardiothorac Surg,1999,16(Suppl 2):S76-S79.
[12]高长青,张涛,李伯君,等.体外循环与非体外循环冠状动脉旁路移植术病人住院费用的对比研究[J].中华胸心血管外科杂志,2005,21(4):231-233.
[13]Bouchard D,Cartier R.Off-pump revascularization of multivessel coronary artery disease has a decreased myocardial infarction rate[J].Eur J Cardiothorac Surg,1998,14(Suppl 1):S20-S24.
[14]高长青,李伯君,肖苍松,等.70岁以上病人非体外循环与常规冠状动脉旁路移植术比较[J].中华胸心血管外科杂志,2002,18(3):150-152.
[15]Loop FD, Lytle BW,Cosgrove DM,et al.Influence of the internal-mammary-artery graft on 10-year survival and other cardiac events[J].N Engl J Med,1986,314(1):1-6.
[16]Lytle BW,Blackstone EH,Loop FD,et al.Two internal thoracic artery grafts are better than one[J].J Horac Cardiovasc Surg,1999,117(5):855-872.
[17]Endo M,Nishida H,Tomizawa Y,et al.Benefit of bilateral over single internal mammary artery grafts for multiple coronary artery bypass grafting[J].Circulation,2001,104(18):2164-2170.
[18]SpoonerTH,HartJC,P ymJ.A two-year,three institution experience with the Medtronic Octopus:Systematic off -pump surgery[J].Ann Thorac Surg,1999,68(4):1478-1481.
[19]Baumgartner FJ,Yokoyama T,Gheissari A,et al.Effect of off-pump coronary artery bypass grafting on morbidity[J].Am J Cardiol,2000,86(9):1021-1022.
[20]Puskas JD,Thourani VH,Marshall JJ,et al.Clinical outcomes,an giographic patency,and resource utilization in 200 consecutive off-pump coronary bypass patients[J].Ann Thorac Surg,2001,71(5):1477-1484.
[21]Blankstein R,Ward RP,Arnsdorf M,et al.Female gender is an independent predictor of operative mortality after coronary artery bypass graft surgery: contemporary analysis of 31 Midwestern hospitals[J].Circulation,2005,112(9 Suppl):323-327.

备注/Memo

备注/Memo:
收稿日期：2010-07-31.作者简介：李扬，住院医师，硕士Email:liy821005@yahoo.com.cn
更新日期/Last Update: 2011-06-02