Comparative study of graft flow between on-pump and off-pump coronary bypass surgery for patients with multivessel coronary artery disease

Objective： To Comparatively study grafts flow between on-pump and off-pump coronary bypass surgery for patients with triple coronary artery disease. Methods ： The grafts flow was studied in 100 patients of OPCAB and compared with 100 cases of CCABG by means of Medi-Stim Butterfly Flowmeter measurement intraoperatively. Results： The mean number of the distal anastomosis was 3.78＋ 1.11 in CCABG group, and 3.83 ＋ 0.93 in OPCAB group. The index of completeness of revascularization in CCABG group was 1.01 ＋ 0.08, and 1.10＋ 0.09 in OPCAB group. The flow of grafts was satisfied in all patients. The PI values were all under 5. There was no significant difference in the mean graft flow and PI value between two groups. Conclusion： OPCAB can provide the same grafts flow and similar completeness of revascularization when compared with CCABG which indicates the similar anastomosis quality of grafts in OPCAB and CCABG groups.     

体外循环下心脏不停跳与非体外循环冠状动脉搭桥术治疗冠状动脉左主干病变的对比研究

目的 对比研究体外循环下行心脏不停跳与非体外循环下冠状动脉搭桥治疗冠状动脉左主干病变的临床效果。方法 180例单纯冠状动脉左主干病变患者分别进入非体外循环下冠状动脉搭桥组(OPCAB组,n=90)和体外循环下心脏不停跳行搭桥组（OPBH,n=90)。两组患者在心绞痛程度、合并慢性阻塞性肺病(COPD)、心肌梗死史和糖尿病、高血压,高血脂,中风,肾功能受损等方面无统计学差异(P＞0.05),但OPBH组低左室射血分数(LVEF)的患者的比例明显多于OPCAB组(P<0．05)。所有患者均采用胸骨正中切口。OPCAB组用单根心包深吊线,引入一橡皮管,帮助暴露各冠状动脉分支,采用心脏局部固定器,辅以腔内分流栓,完成远端吻合。OPBH组在体外循环(CPB)的辅助下,用OPCAB的方法显露冠状动脉各个分支,完成各个吻合。所有患者术终行桥血流定量测定。结果 OPCAB组无1例需转成OPBH。两组人均冠状动脉远端吻合数(OPCAB组：3.22±0.58。OPBH组：3.06±0.72)和再血管化指数相似,术后呼吸支持时间、胸腔引流量和输血量明显少于OPBH组(P<0．05);两组围手术期心肌梗死、出血再开胸、呼吸功能不全、肾功能异常、脑卒中、心房颤动、纵隔炎、下肢切口感染和围术期死亡例数无统计学差异(P>0．05)。结论 对比研究结果显示,两种手术方式均可以取得良好的临床效果。对于低LVEF的患者,OPBH可用于治疗冠状动脉左主干病变,能达到完全性再血管化,虽然出血和输血量较大,术后呼吸支持时间和ICU停留时间较长,但能取得与OPCAB相同的疗效。     

老年冠心病患者非体外循环及体外循环冠状动脉旁路移植术疗效比较

目的 比较非体外循环冠状动脉旁路移植术(OPCABG)及体外循环冠状动脉旁路移植术(CCABG)治疗老年冠心病患者的疗效.方法 选择2015年1月至2017年6月安阳市人民医院年龄≥60岁的冠心病患者152例,按照手术方式不同分为CCABG组83例和OPCABG组69例,比较两组患者围手术期相关指标,并应用中文版健康状况调查表(SF-36)评估患者术前和术后6个月生活质量.结果 两组静脉桥血管远端吻合口数、手术时间、二次开胸率及围手术期死亡例数比较差异无统计学意义(P>0.05);OPCABG组输血量、呼吸机支持时间、ICU天数、住院天数及并发症发生率显著低于CCABG组,差异有统计学意义(P<0.05).OPCABG组SF-36的社会功能、精神功能、总体活力、情感职能及总体健康评分显著高于CCABG组,差异有统计学意义(P<0.05);两组患者在SF-36的躯体疼痛、生理功能及生理职能评分差异无统计学意义(P>0.05).结论 OPCABG治疗老年冠心病患者临床疗效显著,具有手术创伤少,术后并发症少,康复时间短等优点,有利于提高术后生活质量.     

非体外循环和常规体外循环冠状动脉旁路移植术的临床对比研究

冠状动脉旁路移植术(CABG)是手术治疗冠心病的有效方法,目前常规方法是在体外循环心脏停跳下施行CABG(CCAB),但由于体外循环自身存在一定的缺陷,故近十年来国内外相继开展了非体外循环心脏跳动下施行CABG(OPCAB),取得了比较理想的临床效果,目前约占CABG总数的30%.但对这两种方法的临床效果,目前仍存在争议.本研究采用前瞻性研究来客观评价这两种方法的临床效果,现报告如下.     

体外与非体外循环冠脉搭桥术临床对比研究及护理

目的对比研究体外循环冠状动脉搭桥术和非体外循环冠状动脉搭桥术的疗效。方法研究组57例采用非体外循环冠状动脉搭桥术;对照组15例体外循环冠状动脉搭桥术。比较两组手术时间、术中出血量、辅助呼吸时间、术后引流量、ICU监护时间、术后拔管时间、住院总天数、住院总费用等指标。结果研究组手术时间、术中出血量、辅助呼吸时间、术后引流量、ICU监护时间、术后拔管时间、术后住院时间、住院总费用等明显低于对照组（P〈0.05）。研究组术后无1例发生心绞痛,3例术后38h出现窦性心动过速,对照组7例术后24h出现心律紊乱,频发室早。其余恢复良好,均痊愈出院。随防6~36个月,研究组心绞痛消失,疗效满意;对照组术后2例13个月发生充血性心力衰竭,3例心律紊乱,频发室早。结论非体外循环冠状动脉搭桥安全、有效。非体外循环冠状动脉搭桥术比体外循环冠状动脉搭桥术术中心脏创伤小,术后心脏功能恢复快,并发症少,减少护理工作量,值得推广。     

异丙酚-利多卡因-芬太尼复合麻醉在非体外循环冠脉搭桥术中的应用研究

目的探讨异丙酚-利多卡因-芬太尼复合麻醉在非体外循环冠脉搭桥术(OPCAB)中应用的安全性及可行性。方法选择ASAⅡ~Ⅲ级,择期行OPCAB手术患者37例,分为异丙酚-利多卡因-芬太尼组22例(P组)和对照组15例(C组)。记录麻醉前、诱导后、切皮、劈开胸骨、心脏操作、术毕时血压、心率变化;术前、术中、术毕抽血测定CK-MB;并记录两组芬太尼用量,术中心律失常、围手术期心肌缺血和心梗发生例数,术后苏醒、拔管时间、ICU停留及住院时间进行比较。结果两组病人在诱导后及血管吻合时血压、心率均有明显下降(P<0·01);术前、术中、术后CK-MB逐渐上升,但C组上升比P组明显;P组芬太尼用量明显少于C组(P<0·01),P组苏醒及拔管时间均比C组快(P<0·05),两组ICU停留时间、住院时间、心律失常、心梗发生率无明显差异。结论在OPCAB术中异丙酚-利多卡因-芬太尼复合麻醉可维持血流动力学稳定,不增加心肌氧耗,苏醒快,可早期拔管,可安全应用于快通道OPCAB手术麻醉。     

瞬时血流测量技术在不停跳冠状动脉旁路移植术中的应用

目的在不停跳冠状动脉旁路移植术(Off-pump Coronary Artery Bypass Grafting,OPCAB)中应用瞬时血流测量仪(Transit-time Flowmetery,TTFM)测量血管桥的血流量,根据平均血流量、搏动指数(Pulsatility Index,PI)和血流曲线图,判定血管桥的通畅性,及时对不通畅的血管桥进行修正,提高手术效果。方法2001年7月—2005年6月,对256例OPCABG病例的498支血管桥进行血流测量,分析平均血流量、PI和血流曲线图。结果共15例16支血管桥测量结果显示平均血流量偏低、PI过高、血流曲线图不正常三种情况中的一种或几种,检查发现:乳内动脉损伤3支,静脉桥扭曲或旋转7支,吻合口狭窄4支,血管桥张力过大2支,总的血管桥修正率为3%(16/498)。结论TTFM测量血管桥血流量,简便可靠,重复性强,可及时发现不通畅的血管桥并纠正,确保手术效果。     

停跳与不停跳冠状动脉搭桥术效果分析

目的：比较停跳与不停跳冠状动脉搭桥术治疗冠心病的效果。方法：回顾分析2002年1月～2004年1月完成的冠状动脉搭桥术40例，应用体外循环22例，非体外循环18例。对手术方式的选择、主要并发症和围术期治疗进行分析总结。结果：医院内死亡1例，为同术期心肌梗塞：1例术后10d室颤，急症冠脉造影示右冠状动脉内支架闭塞，行经皮冠状动脉腔内成形术（PTCA）治疗，恢复正常。39例顺利出院，随访无心绞痛症状发生，心功能明显改善。结论：合理的选择病人和于术方式、良好的心肌保护、完全再血管化及围术期密切监护治疗是提高冠状动脉搭桥术安全和疗效的关键因素。     

Emergency off-pump coronary artery surgery

Background Off-pump coronary artery bypass grafting is fast-becoming a procedure of choice for elective revascularization in high-risk patients with multi-vessel coronary artery disease. However, the role of off-pump coronary artery bypass grafting for patients with acute coronary syndromes requiring emergency revascularization still requires validation. We present our experience to show the feasibility of off-pump coronary artery surgery as an emergency revascularization technique. Methods From April 2001 to September 2003, emergency (operation within 24 hours after hospitalization) coronary artery bypass grafting without cardiopulmonary bypass (CPB) was performed in 66 patients with a mean age of (66.9±5.4) years (range 49-72 years). They presented acute coronary syndromes with 38 patients on platelet glycoprotein Ⅱb/Ⅲa receptor antagonists. All patients underwent off-pump coronary artery bypass surgery via sternotomy with the intention of complete coronary revascularization.Results An average of 2.9 grafts per patient were performed and the posterior descending artery and marginal branches of the circumflex artery were grafted in 83.3% of the patients. There were 4 events of intraoperative cardiac instability, precipitated by occlusion of right coronary artery or positioning of a cardiomegaly heart, leading to immediate conversion to CPB. The mortality rate was 3% (2/66). Two patients suffered postoperative stroke while three needed hemofiltration for acute renal failure. Post surgery elective coronary angiography (n=46) showed no significant stenosis.Conclusion Emergency off-pump coronary artery surgery with complete revascularization is feasible in patients with acute coronary syndrome with low morbidity and mortality and excellent early results.     

Comparison of drug eluting stent implantation with coronary artery bypass surgery in the treatment of patients with chronic total occlusion and multiple vessel disease

Background  In patients with chronic total occlusion (CTO) and multivessel coronary artery disease, the comparison of surgical and the percutaneous revascularization strategies has rarely been conducted. The aim of this study was to compare long term clinical outcomes of drug eluting stent (DES) implantation with coronary artery bypass surgery (CABG) in the patients with CTO and multivessel disease.

Methods  From a prospective registry of 6000 patients in our institution, we included patients with CTO and multivessel coronary artery disease who underwent either CABG (n=679) or DES (n=267) treatment. Their propensity risk score was used for adjusting baseline differences.

Results  At a median follow-up of three years, propensity score adjusted Cox regression analysis showed that the rate of major adverse cardiac cerebrovascular events (MACCE) was lower in CABG group (12.7% vs. 24.3%, hazard ratio (HR) 1.969, 95% CI 1.219–3.179, P=0.006) mainly due to lower rate of target vessel revascularization in CABG group than in DES group (3.1% vs. 17.2%, HR 16.14, 95% CI 5.739–45.391, P <0.001). The incidence of cardiac death or myocardial infarction (composite end point) was not significantly different between these two groups. On multivariate analysis, the significant predictors of MACCE were only the type of revascularization. Age, left ventricular ejection fraction (LVEF), and complete revascularization were identified as significant predictors of composite end points.

Conclusions  Our study shows that in patients with CTO and multivessel coronary disease, DES can offer comparable long term outcomes in cardiac death and myocardial infraction free survival in comparison with CABG. However, there is an increased rate of MACCE which results from more repeat revascularizations. Obtaining a complete revascularization is crucial for decreasing adverse cardiac events.

     

一站式杂交技术与传统手术治疗复杂冠心病的临床研究

目的 比较一站式杂交技术与胸骨正中切口体外循环冠脉搭桥术的效果和并发症,对一站式杂交技术的疗效和安全性作系统评价.方法 选择行一站式冠脉杂交手术(杂交组)34例和胸骨正中切口体外循环冠脉搭桥术(传统组)34例患者,经左胸小切口在不停跳状态下行左乳内动脉至前降支旁路移植术,手术结束后即行经皮冠状动脉介入治疗(PCI),术后口服阿司匹林及氯吡格雷抗凝.比较两组患者术中、术后及并发症情况.结果 两组患者围术期均无死亡病例.杂交组的手术时间[(257.6±49.1)min]较传统组[(387.0±57.1)min]短,术中出血量[(312.5±86.1)ml]较传统组[(796.9±161.6)ml]少(均P＜0.05),而传统组开通靶血管数[(3.7±0.8)支]比杂交组[(2.9±0.6)支]多(P＜0.05).术后杂交组ICU停留时间[(52.5±23.0)h]、机械通气时间[(18 3±15.1)h]、住院时间[(11.1±2.9)d]较传统组[分别为(122.2±31.3)h、(36.8±22.6)h、(17.7±5.5)d]短(均P＜0.05),而术后杂交组引流量[(657.6±17.8)ml]及住院费用[(12.8±17)万元]均较传统组[分别为(484.3±228.4)ml、(10.5±2.3)万元]多(P＜0.05),但术后输血量无统计学差异(P＞0.05).两组均无院外死亡病例,无脑血管意外、心绞痛或心肌梗死再发.结论 一站式杂交技术治疗复杂冠心病安全、有效,与传统手术比较,创伤更小、恢复更快,值得临床推广应用.     

Cognitive outcome after off-pump and on-pump coronary artery bypass graft surgery: a randomized trial

Context  Coronary artery bypass graft (CABG) surgery is associated with a decline in cognitive function, which has largely been attributed to the use of cardiopulmonary bypass (on-pump procedures). Cardiac stabilizers facilitate CABG surgery without use of cardiopulmonary bypass (off-pump procedures) and should reduce the cognitive decline associated with on-pump procedures. Objective  To compare the effect of CABG surgery with (on-pump) and without (off-pump) cardiopulmonary bypass on cognitive outcome. Design and Setting  Randomized controlled trial conducted in the Netherlands of CABG surgery patients enrolled from March 1998 through August 2000, with 3- and 12-month follow-up. Participants and Intervention  Patients scheduled for their first CABG surgery (mean age, 61 years; n = 281) were randomly assigned to off-pump surgery (n = 142) or on-pump surgery (n = 139). Main Outcome Measures  Cognitive outcome at 3 and 12 months, which was determined by psychologists (blinded for randomization) who administered 10 neuropsychological tests before and after surgery. Quality of life, stroke rate, and all-cause mortality at 3 and 12 months were secondary outcome measures. Results  Cognitive outcome could be determined at 3 months in 248 patients. Cognitive decline occurred in 21% in the off-pump group and 29% in the on-pump group (relative risk [RR], 0.65; 95% confidence interval [CI], 0.36-1.16; P = .15). The overall standardized change score (ie, improvement of cognitive performance) was 0.19 in the off-pump vs 0.13 in the on-pump group (P = .03). At 12 months, cognitive decline occurred in 30.8% in the off-pump group and 33.6% in the on-pump group (RR, 0.88; 95% CI, 0.52-1.49; P = .69). The overall standardized change score was 0.19 in the off-pump vs 0.12 in the on-pump group (P = .09). No statistically significant differences were observed between the on-pump and off-pump groups in quality of life, stroke rate, or all-cause mortality at 3 and 12 months. Conclusion  Patients who received their first CABG surgery without cardiopulmonary bypass had improved cognitive outcomes 3 months after the procedure, but the effects were limited and became negligible at 12 months.      

常规体外循环和非体外循环冠状动脉旁路移植术的对比研究

目的 通过比较常规体外循环冠状动脉旁路移植术(CPBCABG)和非体外循环冠状动脉旁路移植术(OPCABG)患者炎性因子和心肌损伤的差异及远期结果,评价两种术式的优缺点. 方法 48例行择期行冠状动脉旁路移植术患者,随机分成CPBCABG组(n=22)和OPCABG组(n=26).分别麻醉诱导后及术后2 h,8 h,24 h和48 h 5个时间点留取静脉血6 ml.测定白细胞介素6(IL-6)、白细胞介素8(IL-8)、肿瘤坏死因子α(TNF-α)和肌钙蛋白I(cTnI).随访患者心绞痛改善情况及心功能情况,随访时间1.5年. 结果 CPBCABG组术后各项指标均较术前显著升高(P<0.05).OPCAN3组除IL-6,TNFα外其余指标较术前无明显升高,差异无统计学意义(P>0.05),两组术前各项参数间均无统计学差异,术后CPBCABG组各项参数均明显高于OPCAN3组(P<0.05),尤以术后2 h和8 h差异最为明显(P<0.05或P<0.01).随访两组患者均无残留心绞痛,恢复正常生活或工作. 结论 与CPBCABG相比较,OPCAN3可以明显降低围术期炎性反应,减轻心肌损伤,而远期效果同样满意.     

Tei index evaluates left ventricular function changes after on-pump and off-pump coronary artery bypass surgery

Objective： To compare function recovery of left ventricle after off-pump and on-pump coronary artery bypass （OPCAB and ONCAB） using Tel index. Methods： Twenty-four patients with coronary artery disease were enrolled, twelve of which received OPCAB and the others underwent ONCAB. Left ventricular ejection fraction （LVEF）, E/A ratio at mitral orifice and Tel index were measured using transthoracic echocardiography before surgery and 3-7 days, 1 month, 3 months and 6 months after surgery. Results：Tel index of both groups decreased 3-7 days after surgery, with OPCAB group＇s lower than ONCAB group＇s. The difference between pre-and post-OPCAB was significant （P〈0.01）, but not for ONCAB group （P〈0.05）. Tel index of ONCAB decreased more significant than that of OPCAB 1 month after surgery, there was statistical difference between 3-7 days and 1 month after surgery in ONCAB （P〈0.01）. Afterwards, Tel index of the 2 groups decreased steadily with no significant difference between them at other time points. LVEF and E/A ratio decreased at first, then increased gradually, with no statistical differences between the 2 groups at all time points. Conclusion： The recovery of left ventricular function after OPCAB is earlier than ONCAB. Tel index is more sensitive than LVEF and E/A ratio in detecting cardiac function recoveries and can be considered as an accurate and simple method to evaluate left ventricular systolic and diastolic function.     

Cognitive and cardiac outcomes 5 years after off-pump vs on-pump coronary artery bypass graft surgery

Context  Conventional coronary artery bypass graft surgery with use of cardiopulmonary bypass (on-pump CABG) is associated with excellent long-term cardiac outcomes but also with a high incidence of cognitive decline. The effect of avoiding cardiopulmonary bypass (off-pump CABG) on long-term cognitive and cardiac outcomes is unknown. Objective  To compare the effect of off-pump CABG and on-pump CABG surgery on long-term cognitive and cardiac outcomes. Design, Setting, and Participants  The Octopus Study, a multicenter randomized controlled trial conducted in the Netherlands, which enrolled 281 low-risk CABG patients between 1998 and 2000. Five years after their surgery, surviving patients were invited for a follow-up assessment. Intervention  Patients were randomly assigned to receive either off-pump (n = 142) or on-pump (n = 139) CABG surgery. Main Outcome Measure  The primary measure was cognitive status 5 years after surgery, which was determined by a psychologist blinded to treatment allocation who administered 10 standardized validated neuropsychological tests. Secondary measures were occurrence of cardiovascular events (all-cause mortality, stroke, myocardial infarction, and coronary reintervention), anginal status, and quality of life. Results  After 5 years, 130 patients were alive in each group. Cognitive outcomes could be determined in 123 and 117 patients in the off-pump and on-pump groups, respectively. When using a standard definition of cognitive decline (20% decline in performance in 20% of the neuropsychological test variables), 62 (50.4%) of 123 in the off-pump group and 59 (50.4%) of 117 in the on-pump group had cognitive decline (absolute difference, 0%; 95% confidence interval [CI], –12.7% to 12.6%; P>.99). When a more conservative definition of cognitive decline was used, 41 (33.3%) in the off-pump group and 41 (35.0%) in the on-pump group had cognitive decline (absolute difference, –1.7%; 95% CI, –13.7% to 10.3%; P = .79). Thirty off-pump patients (21.1%) and 25 on-pump patients (18.0%) experienced a cardiovascular event (absolute difference, 3.1%; 95% CI, –6.1% to 12.4%; P = .55). No differences were observed in anginal status or quality of life. Conclusion  In low-risk patients undergoing CABG surgery, avoiding the use of cardiopulmonary bypass had no effect on 5-year cognitive or cardiac outcomes. Trial Registration  isrctn.org Identifier: ISRCTN69438133      

肺部肿瘤合并冠心病同期手术治疗经验

目的 总结肺部肿瘤合并冠心病患者同期完成不停跳冠状动脉旁路移植术及肺（叶）切除手术适应证的选择及治疗经验。方法2000年至今肺部肿瘤合并冠心病同期实施不停跳冠状动脉旁路移植及肺（叶）切除手术10例患者,术前肺部肿瘤cTNM分期ⅠB期4例,ⅡA期2例,ⅡB期4例。冠状动脉造影提示左主干病变2例,三支病变7例,单只病变1例。术中完成乳内动脉与左前降支吻合及大隐静脉旁路移植手术,8例同期行肺叶切除加淋巴结清扫,2例肺部分切除。分析术前心肺功能评价的指标及手术适应证的选择依据,总结术中操作、围手术期处理要点。结果10例患者手术过程顺利,平稳度过围手术期,心肺功能恢复良好,均痊愈出院,术后肺部肿瘤病理诊断腺癌5例,鳞癌3例,炎性假瘤2例,pTNM分期ⅠA期1例,ⅡA期4例,ⅡB期3例。结论不停跳冠状动脉旁路移植术同期行肺叶切除手术应严格把握手术指征,正确掌握术中、术后处理原则,同期实施手术治疗安全可行。     

体外循环与非体外循环下冠脉搭桥手术效果的比较

目的对比研究体外循环下冠状动脉搭桥术(CABG)与非体外循环冠状动脉搭桥术(0PCAB)吻合口质量及心肌再血管化的程度.方法连续记录150例OPCAB及120例CABG患者的临床资料,采用t检验或x2检验,对两组相关指标进行对比分析.结果OPCAB与CABG两组比较,术前合并症脑血管事件分别为(26例vs11例)、合并肾功能不全(11例vs 6例),OPCAB组较CABG组多且有显著性差异(P＜0.05).术后机械通气时间[(4.1±2.6)hvs 12.5±8.4)h]、ICU天数[(1.9±0.5)d vs(2.3±0.8)d]、住院天数[(5±2)d vs(7±3)d],以及术后并发症的发生率均有显著性差异(P＜0.05).而平均搭桥支数[(3.1±0.7 vs(3.4±0.8)]、平均动脉桥支数[(1.3±0.5)vs(1.5±0.7)]、有质量问题桥血管数(6/465 vs 4/406)、桥血流波形图、桥血流量、PI值、死亡率(0.8%vs 1.6%)两组无明显差异.结论OPCAB能取得与CABG相同的血管桥吻合口质量和血管桥流量及相同的心肌再血管化及动脉化程度,但术前合并症OPCAB组较CABG组多,而术后并发症则少于CABG组.     

体外循环与非体外循环冠脉搭桥手术早期预后的比较

目的:通过对体外循环下(on-pump)和非体外循环下(off-pump)冠状动脉搭桥手术进行回顾性调查,比较两种手术方法的早期预后效果.方法:从我院2005年1月～2008年6月择期进行的346例冠脉搭桥手术中选择291分为非体外循环组(off-pump组,189例﹚和体外循环组(on-pump组,102例),对两组的术前基本特征,麻醉药用量,手术时间,ICU 停留时间,术后带管时间,输血量以及住院费用、苏醒时间等情况进行分析.结果:两组病人的术前资料基本相似,与off-pump组相比,on-pump组的异体输血量[(4.49±2.56) u]、住院费用[(54 808.41±2 101.52)元]、手术时间[(5.04±1.12 ) h]、苏醒时间[(183±49) min]均高于off-pump组.on-pump组术后呼吸功能异常的比例更高,两组间差异有统计学意义(P＜0.05).两组围术期病死率、住院时间及术后机械通气时间相似,差异无统计学意义(P＞0.05).结论:非体外循环冠脉搭桥手术与体外循环下冠脉搭桥手术一样安全,与on-pump CABG相比,off-pump CABG术后并发症发生率更低,并且住院费用更低,值得进一步推广.     

Effect of nicardipine combined with esmolol on systemic and tissue oxygenation during off-pump coronary artery bypass grafting surgery

Background The hemodynamics and oxygenation severely fluctuated during the off-pump coronary artery bypass grafting (OPCABG). This study aimed at investigating whether or not nicardipine combined with esmolol (1∶10) can maintain systemic and tissue oxygenation during OPCABG.Methods Twenty patients scheduled for OPCABG were divided ramdomly into Group nicardipine (N) and Group nitroglycerine (X) respectively combined with esmolol (E) (Dosage ratio: 1 to 10) (Group N+E and Group X+E) with 10 patients in each group. The mixed solution of N+E or X+E were titrated to maintain mean arterial blood pressure between 70 and 80 mmHg following anesthesia induction. The variables of hemodynamics, arterial blood lactate content (Lac) and gastric intramucosal partial pressure of carbon dioxide were measured at the following time points: after induction of anesthesia (T1), pre-revascularization (T2), grafting of left anterior descending (T3), right coronary descending (T4) and left coronary circumflexus branches (T5), post-revascularization (T6), the end of operation (T7). The delivery of oxygen (DO2), consumption of oxygen (VO2) and gastric intramucosal pH (pHi) were calculated.Results The cardiac index (CI) in Group N+E was significantly increased (P&lt;0.05) as compared with T1 during OPCABG, while it was mildly decreased in Group X+E. The stroke volumes at T4, T5 in Group N+E and at T3-T6 in Group X+E were significantly decreased (P&lt;0.05). The systemic vascular resistance indices in Group N+E were significantly decreased as compared with T1 (P&lt;0.05). The heart rates in these two Groups were significantly elevated intraoperatively (P&lt;0.05). The DO2 after the infusion of N+E was significantly increased (P&lt;0.05) or leveled to T1, and the Lac were within the normal range. But the DO2 in Group X+E was decreased throughout the procedure, reaching significant level at T5 (P&lt;0.05), and the Lac was significantly increased beyond normal range (P&lt;0.05). The pHi in Group N+E was maintained above 7.35 during OPCABG, while it was less than 7.35 from T4 to T7 in Group X+E.Conclusion Nicardipine combined with esmolol (1∶10) regimen may maintain systemic and tissue oxygenation during OPCABG.     

冠状动脉粥样硬化性心脏病老年患者体外与非体外循环冠状动脉搭桥术疗效比较

目的对比老年冠状动脉粥样硬化性心脏病(CAHD)患者体外循环冠状动脉搭桥术(CABG)和非体外循环CABG的手术效果。方法 103例择期行CABG的CAHD患者分为体外循环CABG组50例和非体外循环CABG组53例,对2组患者治疗效果进行比较。结果非体外循环CABG组患者手术时间、呼吸机支持时间、苏醒时间和住院时间均显著短于体外循环CABG组(P<0.05,P<0.01);非体外循环CABG组患者搭桥支数、出血量、输血量和术后血管活性药物用量均显著少于体外循环CABG组(P<0.05,P<0.01);2组患者使用血管类型、重症监护病房住院时间和胸腔引流量比较差异均无统计学意义(P>0.05)。2组患者2次开胸止血、伤口感染延迟愈合、低心排血量综合征、围术期心肌梗死、急性肺水肿、呼吸衰竭和脑血管意外发生率比较差异均无统计学意义(P>0.05);非体外循环CABG组患者心房颤动、室性心律失常和肾功能损伤发生率显著低于体外循环CABG组(P<0.05);2组患者术后病死率比较差异无统计学意义(P>0.05)。结论老年CAHD患者行CABG是安全可行的,且非体外循环CABG的效果优于体外循环CABG。