一站式杂交技术与冠状动脉旁路移植术治疗冠心病多支病变的对比研究

One-stop hybrid coronary revascularization operation and minimally-invasive coronary artery bypass surgery for treatment of multivessel coronary heart disease

摘要:

目的 评价一站式杂交技术在治疗冠状动脉粥样硬化性心脏病（以下简称冠心病）多支病变中的手术安全性及疗效。方法 选取该院行一站式冠状动脉杂交手术患者23 例和胸骨正中切口非体外循环下冠状动脉搭桥术患者23 例，其中杂交组在经胸骨下段小切口以左乳内动脉至左前降支搭桥，术毕行冠状动脉支架介入手术，治疗“罪犯”血管，另外23 例患者行常规胸骨正中非体外循环下冠状动脉搭桥术，比较两组患者的手术效果及并发症发生情况。结果 两组围手术期均无患者死亡。杂交组手术时间较常规组短（P <0.05）。杂交组输注红细胞和血浆量较常规组少（P <0.05）；杂交组术中出血量、24 h 引流量及血肌钙蛋白量较常规组少（P <0.05）；杂交组重症加强护理病房停留时间、机械通气时间及引流管保留时间较常规组短（P <0.05）。结论 一站式杂交技术治疗冠心病多支病变较常规冠状动脉搭桥术具有安全性高、创伤小、并发症少及恢复快等优点，值得临床推广应用。

Abstract:

Objective To evaluate the security and effectiveness of one-stop hybrid coronary revascularization operation (OHCR) for multivessel coronary heart disease. Methods This sudy included 23 patients undergoing OHCR and 23 cases who had off-pump coronary artery bypass graft surgery (OPCABG) through mid-sternal incision in our hospital. In the OHCR group, the internal mammary artery was bypassed to left anterior descending branch through minimal incision in the lower sternum, and then the involved vessel was treated with percutaneous coronary intervention (PCI). The patients in the OPCABG group were treated with traditional OPCABG. The surgical result and complications were compared between the two groups. Results Both groups had no death case in the perioperative period. The operation time of the OHCR group was shorter than that of the OPCABG group (P < 0.05).Compared to the OPCABG group, the volume of red blood cell transfusion, plasma transfusion, intraoperative bleeding and 24-h drainage was smaller, and the serum troponin level was lower in the OHCR group (P < 0.05). The time staying in the Intensive Care Unit, the mechanical ventilation time, and the retention time of drainage tube in the OHCR group were shorter than those in the OPCABG group (P < 0.05). Conclusions OHCR has merits of higher safety, less trauma, fewer complications and faster recovery than the conventional OPCABG in the treatment of multivessel coronary artery disease. So it deserves further clinical application.