[1]杨敏烈,孙寒松,张瑛,等.冠心病合并左室功能不全患者的非体外循环与体外循环下冠状动脉旁路移植术早期结果分析[J].中国微创外科杂志,2009,09(3):261-264.
　Yang Minlie,Sun Hansong,Zhang Ying,et al.Early Outcomes of OnPump and OffPump Isolated Coronary Artery Bypass Grafting in the Patients with Coronary Heart Disease Complicated with Left Ventricular Dysfunction[J].Chinese Journal of Minimally Invasive Surgery,2009,09(3):261-264.
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冠心病合并左室功能不全患者的非体外循环与体外循环下冠状动脉旁路移植术早期结果分析()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
09
期数:
2009年3期
页码:
261-264
栏目:
出版日期:
2009-08-01

文章信息/Info

Title:
Early Outcomes of OnPump and OffPump Isolated Coronary Artery Bypass Grafting in the Patients with Coronary Heart Disease Complicated with Left Ventricular Dysfunction
作者:
杨敏烈; 孙寒松; 张瑛; 罗新锦; 唐跃; 许建屏; 胡盛寿
北京协和医学院中国医学科学院阜外心血管病医院心脏外科，北京100037
Author(s):
Yang Minlie;  Sun Hansong;  Zhang Ying;  et al.
Peking Union Medical College, Department of Cardiac Surgery, Cardiac Institute & Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing 100037, China
关键词:
左室功能不全; 非体外循环; 体外循环; 单纯冠状动脉旁路移植术; 左室射血分数; 左室舒张末径
Keywords:
Left ventricular dysfunction; Onpump coronary artery bypass; Offpump coronary artery bypass; Isolated coronary artery bypass grafting; Left ventricular ejection fraction; Left ventricular enddiastolic dimension
分类号:
R654.2
文献标志码:
A
摘要:
目的比较非体外循环和体外循环下行单纯冠状动脉旁路移植术对冠状动脉粥样硬化性心脏病（冠心病）合并左室功能不全患者的早期疗效。方法1996年11月～2007年12月，对98例冠心病合并左室功能不全患者在非体外循环（offpump coronary artery bypass，OPCAB，n=41）或体外循环（cardiopulmonary bypass，CPB，n=57）下行单纯冠状动脉旁路移植术，2组性别、年龄、体重指数、心功能等级、既往病史及手术移植血管种类差异无显著性。比较2组手术的情况及术后早期心功能变化的情况。结果2组术后2周、3个月左室射血分数（LVEF）、左室舒张末径（LVEDD）均显著改善（P＜005）。与CPB组相比，OPCAB组移植血管数目少［(26±05)支vs(30±04)支,t=-3589,P=0001］,手术时间短［(443±080)h vs (535±124)h,t=-4192,P=0000］，术后住院日短(Z=-4030,P=0000)，呼吸机辅助呼吸时间短(Z=-1985,P=0047)，术后较少应用血管活性药物［23例（561%） vs 44例 (772%), χ2=4907,P=0027］，并发症少［0/41（0%）vs 6/57(105%),P=0039］，术后3个月随访LVEF［(5042±900)% vs (4609±910)%,t=2037,P=0045］和LVEDD［(532±54) mm vs (564±72) mm,t=-2056,P=0043］更理想。结论对冠心病合并左室功能不全患者，单纯的心肌再血管化是一个确切、有效的治疗方法；对该疾病具有相同手术适应证的患者，非体外循环组的早期疗效优于体外循环组。
Abstract:
ObjectiveTo assess and compare the early efficacy of onpump and offpump undergoing isolated coronary artery bypass grafting (ICABG) in patients with coronary heart disease complicated with left ventricular dysfunction.MethodsFrom November 1996 to December 2007, a consecutive series of 98 patients who were diagnosed as having coronary heart disease complicated with left ventricular dysfunction underwent ICABG in our hospital, including 41 cases under offpump coronary artery bypass (OPCAB) and 57 cases of cardiopulmonary bypass (CPB). No significant difference was detected in the sex, age, BMI, heart function, medical history, and the type of grafts between the two groups. Early changes of postoperative cardiac function of the two groups were analyzed and compared statistically. ResultsIn both the groups, the LVEF and LVEDD were significantly increased at 2 weeks and 3 months after operation (P＜005).Compared to the CPB group, the OPCAB group used significantly less grafts［(26±05) vs (30±04) branches, t=-3589, P=0001］, and had shorter operation time ［mean: (443±080) vs (535±124) h, t=-4192, P=0000］, shorter postoperative hospital stay (Z=-4030, P=0000), shorter assisted mechanical ventilation time (Z=-1985, P=0047), less prescription of vasoactive drugs ［23 (561%) vs 44 (772%), χ2=4907, P=0027］, and fewer complications ［0/41(0%) vs 6/57 (105%), P=0039］. Ultrasonic echocardiography performed at 3 months followup showed higher LVEF and LVEDD in the OPCABG group than the CPB group ［LVEF: (5042±900)% vs (4609±910)%, t=2037, P=0045; LVEDD: (532±54) mm vs (564±72) mm, t=-2056, P=0043］.ConclusionsICABG is a reliable and effective treatment for coronary heart disease complicated with left ventricular dysfunction. For patients with same surgical indications, OPCABG group is better than CPB group in early efficacy.

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备注/Memo

备注/Memo:
孙寒松通讯作者
更新日期/Last Update: 2013-08-19