摘要
目的探讨大隐静脉的不同获取方式对冠状动脉旁路移植术(CABG)效果的影响。方法本研究是一项回顾性队列研究。收集2019年3月至2020年4月在阜外华中心血管病医院心血管外科行CABG的患者临床资料,如年龄、性别、合并症等。根据大隐静脉的获取方式将收集的患者分为内镜组(内镜获取大隐静脉)与常规组(传统开放获取大隐静脉)。比较两组患者手术时间、桥血管支数、术中大隐静脉桥血管流量、搏动指数,术后肾功能损伤、术后住院时间、重症监护室入住时间、下肢切口并发症,术后12~18个月桥血管通畅率、再发心绞痛、心肌梗死等资料。结果共纳入132例患者,年龄(63.64±6.78)岁,男94例(71.21%,94/132),其中内镜组58例,常规组74例。两组患者性别、年龄、合并症等基线资料间的差异无统计学意义。两组患者手术时间[(355.50±75.92)min对(346.55±68.74)min,P=0.480]、桥血管支数[2.00(2.00,2.00)对2.00(2.00,2.25),P=0.677]、术中大隐静脉桥血管流量[79.00(52.50,115.50)ml对69.50(46.75,100.50)ml,P=0.196]、大隐静脉桥搏动指数[1.55(1.38,2.20)对1.60(1.30,1.90),P=0.910]、肾功能损伤发生率(37.93%对24.32%,P=0.091)、术后住院天数[10.00(8.00,15.25)d对11.00(9.00,14.25)d,P=0.512]、术后住重症监护室时间[66.13(44.17,98.21)h对66.38(43.81,95.46)h,P=0.757]等差异无统计学意义;术后12~18个月大隐静脉桥血管通畅率(87.7%对87.9%,P=0.938)、再发心绞痛(10.34%对10.81%,P=0.931)、心肌梗死发生率(10.34%对6.76%,P=0.534)差异无统计学意义;无死亡及经皮冠状动脉介入治疗病例,无二次CABG病例。与常规组相比,内镜组下肢切口并发症发生率较低[5.17%(3/58)对16.22%(12/74),P=0.047],差异有统计学意义。结论大隐静脉的获取方式对CABG效果的影响没有差异,但内镜技术可以降低下肢切口并发症发生率。
Objective To explore the effect of different methods of the great saphenous vein harvesting on the outcome of coronary artery bypass grafting(CABG).Methods This study was a retrospective cohort study.The clinical data of patients who underwent CABG in the Cardiovascular Surgery Department of Heart Center of Fuwai Central China Cardiovascular Hospital from March 2019 to April 2020 were collected retrospectively,such as age,gender,complications,etc.The patients were divided into two groups according to the way of obtaining the great saphenous vein:endoscopic group(obtaining the great saphenous vein through endoscope)and conventional group(traditional open access to the great saphenous vein).The operation time,number of CABG intraoperative flow of great saphenous vein graft,pulsatility index(PI),postoperative renal function impairment,postoperative hospital stay,postoperative stay in intensive care unit(ICU),lower extremity incision complications and graft patency rate,recurrent angina,myocardial infarction with follow-up time of[12-18]months were compared between the two groups.Results A total of 132 cases were collected with age(63.64±6.78)years old,94 males(71.21%,94/132),including 58 in endoscopic group and 74 in conventional group.There was no significant difference between the two groups in gender,age,complications and other baseline data(P>0.05).There was no significant difference in terms of operation time[(355.50±75.92)min vs.(346.55±68.74)min,P=0.480],number of coronary artery bypass grafts[2.00(2.00,2.00)vs.2.00(2.00,2.25),P=0.677],intraoperative flow of great saphenous vein graft[79.00(52.50,115.50)ml vs.69.50(46.75,100.50)ml,P=0.196],pulsatility index(PI)of saphenous vein graft[1.55(1.38,2.20)vs.1.60(1.30,1.90),P=0.910],rate of renal function impairment(37.93%vs.24.32%,P=0.091),postoperative hospital stay[10.00(8.00,15.25)d vs.11.00(9.00,14.25)d,P=0.512]and postoperative stay in ICU[66.13(44.17,98.21)h vs.66.38(43.81,95.46)h,P=0.757],between the two groups.There was no statistically significant difference with respect to the patency rate of graft(87.7%vs.87.9%P=0.938),incidence of recurrent angina(10.34%vs.10.81%,P=0.931),and myocardial infarction(10.34%vs.6.76%P=0.534)in either group,no cases of death,percutaneous coronary intervention(PCI)or secondary CABG with follow-up time of[12-18]months.Lower extremity incision complications were lower in the endoscopic group than that in the conventional group[5.17%(12/74)vs.16.22%(3/58)]with the difference statistically significant(P=0.047).Conclusion There was no difference in the effect of the mode of saphenous vein harvesting on the outcome of CABG,but endoscopic techniques can reduce the complication rate of lower extremity incisions.
作者
李传威
葛畅
程兆云
刘前进
孙俊杰
胡俊龙
Li Chuanwei;Ge Chang;Cheng Zhaoyun;Liu Qianjin;Sun Junjie;Hu Junlong(Cardiovascular Surgery Department of Heart Center of Fuwai Central China Cardiovascular Hospital,Henan Provincial People's Hospital,Zhengzhou 450003,China)
出处
《中华心脏与心律电子杂志》
2022年第4期215-220,共6页
Chinese Journal of Heart and Heart Rhythm(Electronic Edition)
基金
国家自然科学基金(31970766)
河南省医学科技攻关计划项目(201601011)。
关键词
冠状动脉旁路移植术
大隐静脉
内镜
桥血管流量
搏动指数
Coronary artery bypass
Great saphenous vein
Endoscope
Flow of great saphenous vein graft
Pulsatility index
作者简介
通信作者:程兆云,Email:chengzhy@zzu.edu.cn。
