[1]张万程,孙俊杰,王 圣,等.非体外循环冠状动脉旁路移植术在高危老年患者中的应用[J].郑州大学学报(医学版),2018,(05):682-686.[doi:10.13705/j.issn.1671-6825.2018.02.049]
 ZHANG Wancheng,SUN Junjie,WANG Sheng,et al.Use of off-pump coronary artery bypass grafting in high-risk elderly patients[J].JOURNAL OF ZHENGZHOU UNIVERSITY(MEDICAL SCIENCES),2018,(05):682-686.[doi:10.13705/j.issn.1671-6825.2018.02.049]
点击复制

非体外循环冠状动脉旁路移植术在高危老年患者中的应用()
分享到:

《郑州大学学报(医学版)》[ISSN:1671-6825/CN:41-1340/R]

卷:
期数:
2018年05期
页码:
682-686
栏目:
应用研究
出版日期:
2018-09-20

文章信息/Info

Title:
Use of off-pump coronary artery bypass grafting in high-risk elderly patients
作者:
张万程孙俊杰王 圣周胜凯王 悦王顺奎程兆云
郑州大学人民医院心血管外科 郑州 450003
Author(s):
ZHANG WanchengSUN Junjie WANG Sheng ZHOU Shengkai WANG YueWANG ShunkuiCHENG Zhaoyun
Department of Cardiovascular Surgery, People's Hospital of Zhengzhou University, Zhengzhou 450003
关键词:
冠心病 冠状动脉旁路移植术 体外循环 高危 老年人
Keywords:
coronary heart disease coronary artery bypass graft cardiopulmonary bypass high risk the elderly
分类号:
R654.2
DOI:
10.13705/j.issn.1671-6825.2018.02.049
摘要:
目的:评价非体外循环冠状动脉旁路移植术(OPCAB)应用于高危老年冠心病患者的可行性、安全性和优势。方法:选取2013年2月至2017年10月在郑州大学人民医院接受单纯冠状动脉旁路移植术(CABG)治疗的560名高危老年冠心病患者,按手术方式分为OPCAB(A组)和常规体外循环CABG(CCABG,B组),比较两组患者的术前资料(年龄、性别、既往病史、EuroSCORE值等)和临床资料(搭桥数目、术后严重并发症、输血等)。结果:A组年龄偏大(P=0.005)、SCr偏高(P=0.004)、EF值偏低(P=0.013),余术前资料差异无统计学意义(P均>0.05); 两组IABP置入率、围术期红细胞输注量、呼吸机使用时间、急性心肌梗死(AMI)、低心排综合征、急性肺损伤/急性呼吸窘迫综合征(ALI/ARDS)、新发急性肾功能不全(ARI)、新发房颤、多器官损伤、院内死亡率等比较,差异有统计学意义(P均<0.001),B组偏高; 两组搭桥数目、完全再血管化率、再次手术、神经系统损伤差异无统计学意义(P均>0.05)。结论:OPCAB应用于高危老年冠心病患者,其围术期红细胞输注及术后并发症显著减少,在肾功能、心肺功能保护方面优势明显,是一种安全、可行的手术方式。
Abstract:
Aim: To evaluate the feasibility, safety and advantages of off-pump coronary artery bypass grafting(OPCAB)in high-risk elderly patients with coronary heart disease.Methods:We selected 560 high-risk elderly patients who accepted coronary artery bypass grafting(CABG)in People's Hospital of Zhengzhou University from February 2013 to October 2017.These patients were divided into two groups, OPCAB(group A)and conventional CABG(group B)according to the surgical procedure. The differences of preoperative data(age, gender, past medical history, EuroSCORE values, etc.)and clinical data(number of bypass grafts, major postoperative complications, blood transfusions, etc.)between group A and Group B were analyzed.Results:The patients in group A was older(P=0.005), SCr was higher(P=0.004), EF was lower(P=0.013), and other preoperative data were not statistically different(all P>0.05); there were differences in IABP insertion rate, perioperative RBC transfusion, ventilator use time, acute myocardial infarction(AMI), low cardiac output syndrome, acute lung injury/acute respiratory distress syndrome(ALI/ARDS), new-onset acute renal insufficiency(ARI), new-onset atrial fibrillation, multiple organ damage, and in-hospital mortality, and the data above in group B were significantly higher than those in group A(all P<0.001); there were no statistical differences in the number of bypass grafts, complete revascularization rate, reoperation, or nervous system injury(all P>0.05).Conclusion: OPCAB significantly reduces perioperative RBC transfusion and postoperative complications in high-risk elderly patients,it has obvious advantages in renal function, heart and lung protection, and is a safe and feasible surgical method.

参考文献/References:

[1] LAMY A,DEVEREAUX PJ,PRABHAKARAN D,et al.Effects of off-pump and on-pump coronary artery bypass grafting at 1year[J].N Engl J Med,2013,368(13):1179
[2] MØLLER CH,PERKO MJ,LUND JT,et al.No major differences in 30-day outcomes in high-risk patients randomized to off-pump versus on-pump coronary bypass surgery: the best bypass surgery trial[J].Circulation,2010,121(4):498
[3] DHURANDHAR V,SAXENA A,PARIKH R,et al.Outcomes of on-pump versus off-pump coronary artery bypass graft surgery in the high risk(AusSCORE > 5)[J].Heart Lung Circ,2015,24(12):1216
[4] PUSKAS JD,THOURANI VH,KILGO P,et al.Off-pump coronary artery bypass disproportionately benefits high-risk patients[J].Ann Thorac Surg,2009,88(4):1142
[5] MARUI A,OKABAYASHI H,KOMIYA T,et al.Benefits of off-pump coronary artery bypass grafting in high-risk patients[J].Circulation,2012,126(11 Suppl 1):S151
[6] KOWALEWSKI M,PAWLISZAK W,MALVINDI PG,et al.Off-pump coronary artery bypass grafting improves short-term outcomes in high-risk patients compared with on-pump coronary artery bypass grafting: meta-analysis[J].J Thorac Cardiovasc Surg,2016,151(1):60
[7] SELLKE FW,CHU LM,COHN WE.Current state of surgical myocardial revascularization[J].Circ J,2010,74(6):1031
[8] NG RR,CHEW ST,LIU W,et al.The inflammatory response between miniaturised and conventional cardiopulmonary bypass after cardiac surgery in an Asian population[J].Perfusion,2015,30(6):487
[9] RAIVIO P,LASSILA R,PETÄJÄ J.Thrombin in myocardial ischemia-reperfusion during cardiac surgery[J].Ann Thorac Surg,2009,88(1):318
[10]GAUDRIOT B,UHEL F,GREGOIRE M,et al.Immune dysfunction after cardiac surgery with cardiopulmonary bypass: beneficial effects of maintaining mechanical ventilation[J].Shock,2015,44(3):228
[11]TSAKIRIDIS K,ZAROGOULIDIS P,VRETZKAKIS G,et al.Effect of lornoxicam in lung inflammatory response syndrome after operations for cardiac surgery with cardiopulmonary bypass[J].J Thorac Dis,2014,6(Suppl 1):S7
[12]PRATO FS,BUTLER J,SYKES J,et al.Can the inflammatory response be evaluated using 18F-FDG within zones of microvascular obstruction after myocardial infarction?[J].J Nucl Med,2015,56(2):299
[13]刘金金,王岳锋,马月华,等.肾功能损害患者行不停跳冠脉搭桥术的短中期预后分析[J].解放军医学杂志,2017,42(6):545
[14]FREELAND K,HAMIDIAN JAHROMI A,DUVALL LM,et al.Postoperative blood transfusion is an independent predictor of acute kidney injury in cardiac surgery patients[J].J Nephropathol,2015,4(4):121
[15]周玉姣,于坤.体外循环红细胞损伤的原因、表现及危害[J].中国体外循环杂志,2015,3(1): 61
[16]MOUSSAVIAN MR,SLOTTA JE,KOLLMAR O,et al.Hemoglobin induces cytotoxic damage of glycine-preserved renal tubules[J].Transpl Int,2007,20(10):884
[17]马超,法宪恩,柳兵,等.冠状动脉旁路移植术后严重神经系统并发症发生的危险因素[J].郑州大学学报(医学版),2015,50(3):404
[18]COSKUN I,COLKESEN Y,DEMIRTURK OS,et al.Pre- and perioperative risk factors predicting neurologic outcomes after coronary artery bypass surgery in patients with pre-existing neurologic events[J].J Stroke Cerebrovasc Dis,2013,22(8):1340
[19]BITARGIL M,ARSLAN C,BABUGHS,et al.Transfusion-related acute lung injury following coronary artery bypass graft surgery[J].Perfusion,2015,30(8):626
[20]VLAAR AP,BINNEKADE JM,PRINS D,et al.Risk factors and outcome of transfusion-related acute lung injury in the critically ill: a nested case-control study[J].Crit Care Med,2010,38(3):771
[21]DHURANDHAR V,SAXENA A,PARIKH R,et al.Comparison of the safety and efficacy of on-pump(ONCAB)versus off-pump(OPCAB)coronary artery bypass graft surgery in the elderly: a review of the ANZSCTS database[J].Heart Lung Circ,2015,24(12):1225

相似文献/References:

[1]张雅娉,陈魁#,阎西艴,等.贝那普利对冠心病患者血清可溶性不规则趋化因子和肿瘤坏死因子α的影响[J].郑州大学学报(医学版),2010,(02):244.
 ZHANG Yaping,CHEN Kui,YAN Xifu,et al.Effect of benazepril on serum levels of soluble fractalkine and TNFα in coronary heart disease patients[J].JOURNAL OF ZHENGZHOU UNIVERSITY(MEDICAL SCIENCES),2010,(05):244.
[2]张金盈△,厉菁,姚海木,等.冠心病患者血浆sOX40L、MIF水平与冠状动脉病变程度的关系*[J].郑州大学学报(医学版),2009,(04):742.
 ZHANG Jinying,LI Jing,YAO Haimu,et al.Relationship between plasma sOX40L,MIF level and the severity of coronary lesions in patients with coronary heart disease[J].JOURNAL OF ZHENGZHOU UNIVERSITY(MEDICAL SCIENCES),2009,(05):742.
[3]崔红玲,郑海军.冠心病患者血清淀粉样蛋白A和超敏C反应蛋白检测[J].郑州大学学报(医学版),2009,(04):887.
[4]冯文化,李玉东,杨守忠,等.不同剂量阿托伐他汀对冠心病患者血脂及血管内皮功能的影响[J].郑州大学学报(医学版),2009,(01):223.
[5]朱庆华)△,王桂芳),张小俊),等.不同程度冠状动脉病变患者血清胆红素、尿酸水平检测[J].郑州大学学报(医学版),2009,(03):646.
 ZHU Qinghua),WANG Guifang),ZHANG Xiaojun),et al.Determination of serum billirubin and uric acid level in patients with different lesion degree coronary heart disease[J].JOURNAL OF ZHENGZHOU UNIVERSITY(MEDICAL SCIENCES),2009,(05):646.
[6]李素兰,刘杰,谢静.64排螺旋CT冠状动脉造影检查816例体会[J].郑州大学学报(医学版),2010,(04):671.
 [J].JOURNAL OF ZHENGZHOU UNIVERSITY(MEDICAL SCIENCES),2010,(05):671.
[7]赵晓燕,杨海波,张金盈#,等. 冠状动脉临界病变的血管内超声检测[J].郑州大学学报(医学版),2011,(03):485.
 [J].JOURNAL OF ZHENGZHOU UNIVERSITY(MEDICAL SCIENCES),2011,(05):485.
[8]霍志芳,陈魁#,阎西艴,等.冠心病患者血清趋化因子和白细胞介素18水平分析[J].郑州大学学报(医学版),2011,(05):717.
 HUO Zhifang,CHEN Kui,YAN Xifu,et al.Levels of serum FKN and interleukin18 in patients with coronary heart disease[J].JOURNAL OF ZHENGZHOU UNIVERSITY(MEDICAL SCIENCES),2011,(05):717.
[9]王小泉),张沛),梁菁),等.伴冠心病牙周炎患者牙周临床指标和血清TNFα的分析*[J].郑州大学学报(医学版),2012,(03):356.
 WANG Xiaoquan),ZHANG Pei),LIANG Jing),et al.Testing of periodontal clinical indicators and serum TNFα level in periodontal patients with coronary heart disease[J].JOURNAL OF ZHENGZHOU UNIVERSITY(MEDICAL SCIENCES),2012,(05):356.
[10]刘娟),赵红宇)#,章锦才),等.伴冠心病牙周炎患者PISA与血脂的关系*[J].郑州大学学报(医学版),2014,(02):274.
 LIU Juan,ZHAO Hongyu),ZHANG Jincai,et al.Relationship between periodontal inflamed surface area and blood fat in periodontal patients with coronary heart disease[J].JOURNAL OF ZHENGZHOU UNIVERSITY(MEDICAL SCIENCES),2014,(05):274.

备注/Memo

备注/Memo:
【基金项目】河南省医学科技攻关计划省部共建项目(201601011); 国家临床重点专科项目(2011)
【作者简介】程兆云,通信作者,男,1964年6月生,博士,主任医师,教授,研究方向:冠心病的外科治疗,E-mail:13903712068@163.com
更新日期/Last Update: 2018-09-20