体外膜肺氧合-常规体外循环转换与非停跳下高危冠状动脉旁路移植术的比较

摘要

Objective To compare the perioperative characteristics and long term outcomes between extracorporeal membrane oxygenation (ECMO)-conventional cardiopulmonary switch (experimental group,26 cases) and off-pump high-risk coronary artery bypass grafting (OPCABG group,24cases).Methods Perioperative characteristics and survival rate were retrospectively analyzed between experimental group and OPCABG group.Long term survival rates without major cardiovascular adverse events (MACE) were comparatively analyzed via Kaplan-Meier curves.Results The average Euroscore value were 11.7 ± 2.4 and 10.9 ± 2.0,respectively(P =0.208).The experimental group had a higher complete revascularization rate (96.2％ vs.66.7％,P =0.009),a shorter length of postoperative ECMO support [(33.1±23.6)h vs.(80.8±18.5)h],an intensive care unit stay[(4.8±1.1)d vs.(10.2±9.0)d]and a hospital stay [(17.7±6.3)d vs.(28.2±17.5)d] (all P＜0.05) as compared with OPCABG group.Preoperative New York Heart Association (NYHA) grading of cardiac function (r =0.511,P =0.008) and intraoperative ultrafiltration volume (r =-0.442,P =0.024) were significantly correlated with postoperative ECMO continuation in the experimental group.The follow-up period was (45.4 ± 15.2) months.The experimental group had a higher survival rate without MACE than had the OPCABG group (Log-rank test:x2=4.828,P=0.028).Conclusions The ECMO-conventional cardiopulmonary switch mode might facilitate a higher complete revascularization,a lower incidence of postoperative morbidities and improve the longterm survival rate without MACE for patients with high risks.%目的 比较体外膜肺氧合(ECMO)-常规体外转流转换(实验组26例)和非停跳下行高危冠状动脉(冠脉)旁路移植术(CABG)的围术期特点及远期结局. 方法 回顾分析实验组和非停跳冠脉旁路移植术(OPCABG24例)两组患者的围术期资料及存活出院率.Kaplan-Meier曲线比较远期无主要心血管不良事件(MACE)生存率. 结果 术前Euroscore评分分别为(11.7±2.4)分和(10.9±2.0)分(t=-1.268,P=0.208).和OPCABG组相比,实验组完全再血管化率更高[66.7％比96.2％,x2=7.352,=P=0.009],术后ECMO辅助时间[(33.1±23.6)h比(80.8±18.5)h]、监护病房停留时间[(4.8±1.1)d比(10.2±9.0)d]和住院时间[(17.7±6.3)d比(28.2±17.5)d]均更短(均P＜0.05).实验组术前纽约心脏协会心功能分级(r=0.511,P=0.008)和术中超滤量(r=-0.442,P=0.024)与术后ECMO继续辅助相关.随访(45.4±15.2)个月,实验组无MACE生存率优于OPCABG组(Log-rank test:x2=4.828,P=0.028). 结论 ECMO-常规体外转流转换模式可能更有利于高危患者实现冠脉完全再血管化,降低术后并发症发生率,提高远期无MACE生存率.