CAJ | 학술논문

目的：探讨择期分站式杂交（ Hybrid）手术治疗冠状动脉多支血管病变的效果。方法选取2012年12月～2013年12月因冠状动脉多支血管病变在我院心脏中心行择期分站式Hybrid手术30例（ Hybrid组），按手术时间、年龄、性别、术前心功能状态、血管病变程度等从同期择期非体外循环冠状动脉旁路移植（ off－pump coronary artery bypass，OPCAB）手术患者数据库中1∶1抽取30例（ OPCAB组），进行回顾性比较。所有患者术后3个月时采用电话问卷方式进行随访。结果Hybrid组手术时间（124．8±22．2）min，明显短于OPCAB组（211．8±28．2）min（t＝13．277，P＝0．000）；Hybrid组术中出血量（144．5±117．1）ml，明显少于OPCAB组（480．0±261．3）ml（t＝6．418，P＝0．000），且Hybrid组术后输血量和输血浆量亦明显少于OPCAB组（P＜0．05）。 Hybrid组术后呼吸机时间[（8．3±4．6）h vs．（13．6±9．3）h，t＝2．798， P＝0．007]、监护时间[（26．4±15．6）h vs．（51．0±40．0）h，t＝3．138， P＝0．003]均较OPCAB组显著缩短。 Hybrid组PCI时间距手术（6．1±2．6） d，植入支架（2．6±1．9）枚。 Hybrid组术后肝酶峰值、血肌酐峰值与OPCAB组均无显著性差异（ P＞0．05）。2组患者均无住院期间死亡。术后3个月电话随访，均存活，无再入院，无再发脑梗死、心肌梗死、肾功能衰竭，也无明显心绞痛症状。结论分站式杂交手术处理冠状动脉多支血管病变安全有效，严格执行围手术期抗凝策略下分站式杂交手术能有效减少出血及用血，且不增加围手术期心肌梗死的发生。
목적：탐토택기분참식잡교（ Hybrid）수술치료관상동맥다지혈관병변적효과。방법선취2012년12월～2013년12월인관상동맥다지혈관병변재아원심장중심행택기분참식Hybrid수술30례（ Hybrid조），안수술시간、년령、성별、술전심공능상태、혈관병변정도등종동기택기비체외순배관상동맥방로이식（ off－pump coronary artery bypass，OPCAB）수술환자수거고중1∶1추취30례（ OPCAB조），진행회고성비교。소유환자술후3개월시채용전화문권방식진행수방。결과Hybrid조수술시간（124．8±22．2）min，명현단우OPCAB조（211．8±28．2）min（t＝13．277，P＝0．000）；Hybrid조술중출혈량（144．5±117．1）ml，명현소우OPCAB조（480．0±261．3）ml（t＝6．418，P＝0．000），차Hybrid조술후수혈량화수혈장량역명현소우OPCAB조（P＜0．05）。 Hybrid조술후호흡궤시간[（8．3±4．6）h vs．（13．6±9．3）h，t＝2．798， P＝0．007]、감호시간[（26．4±15．6）h vs．（51．0±40．0）h，t＝3．138， P＝0．003]균교OPCAB조현저축단。 Hybrid조PCI시간거수술（6．1±2．6） d，식입지가（2．6±1．9）매。 Hybrid조술후간매봉치、혈기항봉치여OPCAB조균무현저성차이（ P＞0．05）。2조환자균무주원기간사망。술후3개월전화수방，균존활，무재입원，무재발뇌경사、심기경사、신공능쇠갈，야무명현심교통증상。결론분참식잡교수술처리관상동맥다지혈관병변안전유효，엄격집행위수술기항응책략하분참식잡교수술능유효감소출혈급용혈，차불증가위수술기심기경사적발생。
Objective To investigate the efficacy of two-staged hybrid technique for the multiple coronary artery revascularization. Methods A total of 30 patients who underwent two-staged hybrid technique surgery because of coronary multivessel lesions in this center from December 2012 to December 2013 were included retrospectively.Another group of 30 patients who underwent conventional off-pump coronary artery bypass ( OPCAB) at the same period were matched 1:1 by age, operator and preoperative baseline.Differences of the clinical data were compared between the two groups. Results The hybrid group had shorter operation time [(124.8 ±22.2) min vs.(211.8 ±28.2) min,t=13.277, P=0.000] and less blood loss [(144.5 ±117.1) ml vs. (480.0 ±261.3) ml, t=6.418,P=0.000] as compared with the OPCAB group.And the blood and serum transfusion volume was significantly less in the hybrid group than that in the OPCAB group (P<0.05).The hybrid group had significantly shorter length of mechanical ventilation [(8.3 ±4.6) h vs.(13.6 ±9.3) h, t=2.798, P=0.007] and ICU stay [(26.4 ±15.6) h vs.(51.0 ± 40.0) h, t=3.138, P=0.003] than those in the OPCAB group.There was no difference between two groups in the postoperative peak of ALT, TNI and serum creatinine (P>0.05).There were no death during hospitalization in both groups.According to the telephone follow-up for 3 months after surgery, there was no death, readmission, cerebral infarction, myocardial infarction, renal failure, or angina in both groups. Conclusions The two-staged hybrid procedure is safe and feasible for multiple coronary artery revascularization.With intensive anticoagulation and antithrombotic treatment, the hybrid procedure bears reduced perioperative bleeding, low risk of perioperative myocardial infarction, and short time of hospitalization.