中国胸心血管外科临床杂志

中国胸心血管外科临床杂志

糖尿病患者中常规应用双侧乳内动脉搭桥早期结果分析

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目的 分析合并糖尿病对双侧乳内动脉(BIMA)冠状动脉旁路移植术(CABG)手术效果的影响。 方法 2015 年 12 月至 2017 年 8 月,我科应用 BIMA 行搭桥手术的患者共 182 例,其中男 153 例,女 29 例,年龄(56.5±6.8)岁。按是否合并糖尿病进行分组,并应用倾向评分匹配进行配对,分为糖尿病组(n=66)和无糖尿病组(n=66)。其中糖尿病组男 53 例,女 13 例,年龄(57.8±7.2)岁。无糖尿病组男 56 例,女 10 例,年龄(56.3±6.0)岁。回顾性分析两组术中情况、术后并发症及术后 3 月复查冠状动脉计算机断层扫描血管造影(CTA)的情况,并分析糖化血红蛋白(Hb1Ac)对上述指标的影响。 结果 倾向评分匹配后糖尿病组和非糖尿病组的各项术前指标无统计学差异。术后两组胸骨切口并发症无统计学差异(P=0.466)。术后 3 月冠脉 CTA 提示两组乳内动脉(IMA)和大隐静脉(SVG)通畅率无统计学差异(P=0.730、0.684)。术前 HbA1c 异常者 54 例,其术后胸骨切口并发症显著高于 HbA1c 正常组(P=0.006)。出现胸骨切口并发症者 HbA1c 水平显著高于无胸骨切口并发症者(P=0.016)。 结论 合并糖尿病并不增加胸骨切口并发症等围手术期并发症,不应成为应用 BIMA 搭桥的顾虑。但对于合并糖尿病的患者,应注意将糖化血红蛋白控制在正常水平。

Objective To evaluate the influence of diabetes on coronary artery bypass graft (CABG) surgery using bilateral internal mammary artery (BIMA). Methods From Dec. 2015 to Aug. 2017, 182 patients (153 males, 29 females, age of 56.5±6.8 years) underwent CABG using BIMA. The propensity score was used to create matched diabetes (n=66) and non-diabetes (n=66) cohorts. The operative data, post-operative outcomes and coronary computed tomographic angiography (CTA) of the diabetes group (55 males, 13 females, age of 57.8±7.2 years) and non-diabetes group (56 males, 10 females, age of 56.3±6.0 years) were analyzed retrospectively. Results There was no peri-operative mortality. There was no difference in operative sternal wound complication (P=0.466), or graft patency (P=0.730 for internal mammary arteries and 0.684 for saphenous vein grafts) between matched diabetes and non-diabetes groups. However, patents with elevated glycated hemoglobin (HbA1c) (n=54) had more sternal wound complications (P=0.006). Conclusion BIMA grafting may be performed routinely even in diabetic patients, without increased complications. However, elevated HbA1c level should be avoided to reduce sternal wound complication.

关键词: 冠状动脉旁路移植术; 双侧乳内动脉; 糖尿病

Key words: Coronary artery bypass graft; bilateral internal mammary artery; diabetes

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