摘要
目的比较冠心病合并糖尿病患者行微创冠状动脉旁路移植术与传统开胸冠状动脉旁路移植术的安全性与疗效。方法回顾性纳入2019—2021年于北京安贞医院微创心脏外科中心单一医疗组行冠状动脉旁路移植术患者。根据手术方式,将患者分为微创组和常规组。收集患者围手术期及术后随访资料,主要结局指标包括全因死亡、心肌梗死、脑血管事件、再次血运重建和伤口愈合不良发生率等。结果共纳入140例患者,其中微创组66例,男56例、女10例,年龄(61.83±8.94)岁;常规组74例,男55例、女19例,年龄(58.61±8.26)岁。与常规组相比,微创组中位手术时间更长(4.50 h vs.4.00 h,P=0.005),术中出血量更少(600.00 mL vs.700.00 mL,P=0.020)、手术伤口二次清创缝合率更低(4.5%vs.16.2%,P=0.023)。中位随访时间均为2.54年,随访期间累积主要不良心脑血管事件(7.6%vs.5.4%)、全因死亡(0.0%vs.0.0%)、心肌梗死(3.0%vs.2.7%)、脑血管事件(4.5%vs.2.7%)、再次血运重建(0.0%vs.0.0%)发生率差异均无统计学意义(P>0.05)。结论对于冠心病合并糖尿病患者,微创冠状动脉旁路移植术能够达到与常规手术同等的血运重建效果,且微创手术能够有效减少糖尿病患者胸部伤口愈合不良、术后机体功能恢复缓慢等不良临床结局/并发症。
Objective To compare the safety and efficacy of minimally invasive coronary artery bypass grafting(MICS CABG)and traditional CABG in patients with coronary heart disease(CHD)and diabetes mellitus(DM).Methods From 2019 to 2021,the patients who received CABG by the same medical group in the Minimally Invasive Cardiac Surgery Center of Beijing Anzhen Hospital were retrospectively enrolled.According to the surgery methods,the patients were divided into two groups:a MICS CABG group and a conventional group.The perioperative and postoperative follow-up data of patients were collected.The main observation results included all cause death events,myocardial infarction,cerebrovascular,revascularization,and adverse wound healing.Results According to the inclusion and exclusion criteria,140 patients were enrolled,including 66 patients in the MICS CABG group[56 males and 10 females,aged(61.83±8.94)years],and 74 patients in the conventional group[55 males and 19 females,aged(58.61±8.26)years].Compared with the conventional group,patients in the MICS CABG group had longer median surgical time(4.50 h vs.4.00 h,P=0.005),less intraoperative bleeding(600.00 mL vs.700.00 mL,P=0.020),and a lower rate of secondary debridement and suturing of surgical wounds(4.5%vs.16.2%,P=0.023).The median follow-up time was 2.54 years.There was no statistically significant difference in the cumulative incidence of major adverse cardiac and cerebrovascular events(7.6%vs.5.4%),all-cause mortality(0.0%vs.0.0%),myocardial infarction(3.0%vs.2.7%),cerebrovascular events(4.5%vs.2.7%),or revascularization(0.0%vs.0.0%)between the two groups of patients during the postoperative follow-up(P>0.05).Conclusion MICS CABG can achieve the same revascularization effect as traditional CABG in patients with CHD and DM.MICS CABG can effectively reduce adverse clinical outcomes or complications such as adverse chest wound healing and slow postoperative recovery of body function in patients with DM.
作者
赵广鑫
梁林
柳佳吉
马小龙
迟立群
孔晴宇
ZHAO Guangxin;LIANG Lin;LIU Jiaji;MA Xiaolong;CHI Liqun;KONG Qingyu(Minimally Invasive Cardiac Surgery Center,Beijing Anzhen Hospital,Capital Medical University,Beijing,100029,P.R.China)
出处
《中国胸心血管外科临床杂志》
北大核心
2025年第10期1447-1454,共8页
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
基金
首都卫生研究与发展专项资助(2018-2-1052)。
关键词
微创冠状动脉旁路移植术
糖尿病
冠心病
回顾性研究
Minimally invasive coronary artery bypass grafting
diabetes mellitus
coronary heart disease
retrospective study
