中国胸心血管外科临床杂志

中国胸心血管外科临床杂志

一站式复合技术与非体外循环冠状动脉旁路移植术治疗合并糖尿病的多支冠状动脉病变的病例对照研究

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目的 比较一站式复合再血管化技术与非体外循环下冠状动脉旁路移植术(off-pump coronary artery bypass grafting,OPCAB)治疗合并糖尿病的冠状动脉多支病变的术后早期及中期随访结果。 方法 2010 年 1 月至 2015 年 1 月,共 132 例合并糖尿病冠状动脉多支病变患者在阜外医院行一站式复合再血管化治疗。应用倾向性评分法筛选 264 例 OPCAB 患者与一站式复合技术组患者进行 2∶1 配对。 结果 与 OPCAB 相比,一站式复合技术组术后胸腔引流管引流量[618(420,811)ml vs. 969(711,1 213)ml,P<0.001]显著减少,降低了血制品使用率(19.7%vs. 34.1%,P=0.026),缩短了呼吸机使用时间[11.6(8.2,14.8)h vs. 16.0(12.1,18.7)h,P<0.001]和 ICU 停留时间[21.5(18.8,42.0)hvs. 44.6(23.7,70.1)h,P<0.001]。两组中期 40 个月随访期间主要心脑血管不良事件(major adverse cardiac or cerebrovascular events,MACCE)发生率差异无统计学意义(6.8%vs. 9.0%,P=0.826),一站式复合技术组显著降低了术后脑血管事件发生率(0% vs. 3.0%,P=0.029)。 结论 对于合并糖尿病的冠状动脉多支病变患者,一站式复合再血管化技术提供了另一种安全、有效的治疗选择;与 OPCAB 相比,降低了围术期创伤,获得了相似的中期治疗效果。

Objective To compare the in-hospital and midterm outcomes after simultaneous hybrid coronary revascularization (HCR) with off-pump coronary artery bypass grafting (OPCAB) in diabetic patients with multivessel coronary artery disease. Methods One hundred thirty-two diabetic patients with multivessel coronary artery disease underwent one-stop HCR at Fuwai Hospital from January 2010 to January 2015. These patients were 1∶2 matched with those who underwent OPCAB using propensity score matching. Results Simultaneous HCR had less chest tube drainage (618 (420, 811) ml vs. 969 (711, 1 213)ml, P<0.001), lower transfusion rate (19.7%vs. 34.1%, P=0.026), shorter mechanical ventilation time (11.6 (8.2, 14.8) h vs. 16.0 (12.1, 18.7) h, P<0.001), and shorter stay in intensive care unit (21.5 (18.8, 42.0) hvs. 44.6 (23.7, 70.1) h, P<0.001) than OPCAB. During over median 40 months follow-up, simultaneous HCR offered similar major adverse cardiac or cerebrovascular events (MACCE) rate (6.8%vs 9.0%, P=0.826), but lower stroke rate (0% vs 3.0%, P=0.029), compared with OPCAB. Conclusion For selected patients with diabetes, simultaneous HCR provides a safe and effective revascularization alternative. It decreases perioperative invasiveness and incurred similar and favorable midterm outcomes with OPCAB.

关键词: 复合技术; 冠状动脉旁路移植术; 糖尿病

Key words: Hybrid coronary revascularization; coronary artery bypass grafting; diabetes

引用本文: 沈刘忠, 宋之昭, 胡盛寿, 徐波, 吴永健, 吕锋, 熊辉, 李立环. 一站式复合技术与非体外循环冠状动脉旁路移植术治疗合并糖尿病的多支冠状动脉病变的病例对照研究. 中国胸心血管外科临床杂志, 2017, 24(12): 916-922. doi: 10.7507/1007-4848.201707058 复制

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