Objective To compare the clinical results of on-pump and off-pump coronary bypass surgery in patients with triple-vessel disease. Methods A total of 300 consecutive isolated multiple CABG patients entered into off-pum...Objective To compare the clinical results of on-pump and off-pump coronary bypass surgery in patients with triple-vessel disease. Methods A total of 300 consecutive isolated multiple CABG patients entered into off-pump coronary artery bypass (OPCAB group, n=150) or CABG with cardiopulmonary bypass (CPB) (CCABG group, n=150). There were no significant difference regarding the degree of angina, history of myocardial infarction, diabetes and left main disease between two groups. The ejection fraction in OPCAB before surgery was lower than CCABG (P<0.01). More patients had a history of stroke, and abnormal renal function in OPCAB pre-operatively( P< 0.01 ). Single deep pericardial stay suture with a sling snared down was used to expose the target vessels in OPCAB, along with a stabilizer and a coronary shunt. Medi-Stim Butterfly Flowmeter was used to measure the flow of grafts in both groups. Results No one in OPCAB needed to convert to CCABG. The number of the distal anastomosis and the index of completeness of revisualization (ICR) were similar in both groups. The respiratory support time, the volume of chest tube drainage and blood transfusion were less in OPCAB than in CCABG post-operatively (both P<0.01). The incidence of pulmonary dysfunction and renal insufficiency were less in OPCAB than in CCABG post-operatively ( both P<0.05 ) . There was no significant difference in the mortality and other morbidities (peri-opetative MI, stroke, atrial fibrillation). Conclusion OPCAB can be applied to patients with triple vessels disease and achieved similar completeness of revascularization, similar early surgical results with shorter respiratory support, reduced transfusion requirement, less pulmonary dysfunction and abnormal renal function.展开更多
目的·应用电阻抗成像技术(electrical impedance tomography,EIT)确定不停跳冠状动脉旁路移植术(off pump coronary artery bypass grafting surgery,OPCAB)术后最合适的呼气末正压(positive end expiratory pressure,PEEP),以达...目的·应用电阻抗成像技术(electrical impedance tomography,EIT)确定不停跳冠状动脉旁路移植术(off pump coronary artery bypass grafting surgery,OPCAB)术后最合适的呼气末正压(positive end expiratory pressure,PEEP),以达到改善肺通气分布情况、优化肺复张的效果。方法·入选2017年1—12月于上海交通大学附属胸科医院行OPCAB的105例患者。采用随机数余数分组法将患者分为实验组54例,对照组51例。EIT观察术后肺通气的4个兴趣区(region of interest,ROI)。对照组应用3 cm H2O PEEP;实验组调整PEEP值由0 cm H2O逐步升高至14 cm H2O,每次增加2 cm H2O,并应用最适PEEP。比较2组术后氧合指数(PaO_2/FiO_2)和肺部并发症的差异。结果·105例患者中死亡2例(1.90%),术后肺部并发症发生19例(18.10%)、肺部感染3例(2.86%)、肺不张19例(18.10%)、胸腔积液19例(18.10%)。OPCAB术后最适PEEP区间为6～9 cm H2O。实验组应用最适PEEP后,PaO_2/FiO_2显著升高(P=0.00)。与对照组相比,实验组术后肺部并发症发生率显著降低(P=0.02)。结论·应用EIT可实时直观监测OPCAB术后肺通气分布情况,滴定适合肺复张的PEEP;能够显著减少OPCAB术后肺部并发症,改善PaO_2/FiO_2,减少ICU停留时间及机械通气时间。展开更多
文摘Objective To compare the clinical results of on-pump and off-pump coronary bypass surgery in patients with triple-vessel disease. Methods A total of 300 consecutive isolated multiple CABG patients entered into off-pump coronary artery bypass (OPCAB group, n=150) or CABG with cardiopulmonary bypass (CPB) (CCABG group, n=150). There were no significant difference regarding the degree of angina, history of myocardial infarction, diabetes and left main disease between two groups. The ejection fraction in OPCAB before surgery was lower than CCABG (P<0.01). More patients had a history of stroke, and abnormal renal function in OPCAB pre-operatively( P< 0.01 ). Single deep pericardial stay suture with a sling snared down was used to expose the target vessels in OPCAB, along with a stabilizer and a coronary shunt. Medi-Stim Butterfly Flowmeter was used to measure the flow of grafts in both groups. Results No one in OPCAB needed to convert to CCABG. The number of the distal anastomosis and the index of completeness of revisualization (ICR) were similar in both groups. The respiratory support time, the volume of chest tube drainage and blood transfusion were less in OPCAB than in CCABG post-operatively (both P<0.01). The incidence of pulmonary dysfunction and renal insufficiency were less in OPCAB than in CCABG post-operatively ( both P<0.05 ) . There was no significant difference in the mortality and other morbidities (peri-opetative MI, stroke, atrial fibrillation). Conclusion OPCAB can be applied to patients with triple vessels disease and achieved similar completeness of revascularization, similar early surgical results with shorter respiratory support, reduced transfusion requirement, less pulmonary dysfunction and abnormal renal function.
文摘目的·应用电阻抗成像技术(electrical impedance tomography,EIT)确定不停跳冠状动脉旁路移植术(off pump coronary artery bypass grafting surgery,OPCAB)术后最合适的呼气末正压(positive end expiratory pressure,PEEP),以达到改善肺通气分布情况、优化肺复张的效果。方法·入选2017年1—12月于上海交通大学附属胸科医院行OPCAB的105例患者。采用随机数余数分组法将患者分为实验组54例,对照组51例。EIT观察术后肺通气的4个兴趣区(region of interest,ROI)。对照组应用3 cm H2O PEEP;实验组调整PEEP值由0 cm H2O逐步升高至14 cm H2O,每次增加2 cm H2O,并应用最适PEEP。比较2组术后氧合指数(PaO_2/FiO_2)和肺部并发症的差异。结果·105例患者中死亡2例(1.90%),术后肺部并发症发生19例(18.10%)、肺部感染3例(2.86%)、肺不张19例(18.10%)、胸腔积液19例(18.10%)。OPCAB术后最适PEEP区间为6～9 cm H2O。实验组应用最适PEEP后,PaO_2/FiO_2显著升高(P=0.00)。与对照组相比,实验组术后肺部并发症发生率显著降低(P=0.02)。结论·应用EIT可实时直观监测OPCAB术后肺通气分布情况,滴定适合肺复张的PEEP;能够显著减少OPCAB术后肺部并发症,改善PaO_2/FiO_2,减少ICU停留时间及机械通气时间。
