快通道拔管在全动脉冠脉旁路移植术的多中心临床效果

doi:10.6040/j.issn.1671-7554.0.2024.0805

摘要/Abstract

摘要： 目的评价全动脉重建(total arterial revascularization, TAR)冠脉旁路移植术(coronary bypass grafting, CABG)实施快通道拔出气管插管(fast-track extubation, FTE)的安全与效果。方法收集2018年1月至2024年5月34所心脏中心进行TAR患者术后FTE(定义为术后6 h以内拔出气管插管)的临床资料,对围手术期病例资料与随访数据等进行分析。结果 640例TAR中,共有221例患者行FTE,其中男180例、女41例,年龄(55.5±11.7)岁。三支病变171例,双支病变50例。其中,左主干病变70例。术前合并糖尿病75例。TAR均为体外循环下单纯CABG术,共取左内乳动脉桥 201支、左桡动脉桥221支、右桡动脉桥200支、游离右内乳桥21支。复合Y或T型桥31支,单支桥612支。远端吻合口(3.35±0.7)个。气管插管时间(3.5±2.7)h,ICU 时间(23.5±12.9)h。术后住院时间(7.5±3.1)d。手术死亡1例。其他病例无再次插管。17例术中安装主动脉球囊反搏。新发房颤22例,前臂血肿11例,低氧血症13例,急性肾功能不全6例,均治愈出院。无胸骨感染发生。随访(54.3±7.5)个月,随访率90.91%;同术前相比,左室射血分数有显著性改善［(60.0%±5.3%)vs.(55.1%±7.3%),t=11.16, P<0.001］,左室舒张末内径减小［(51.6±2.2)mm vs.(55.0±7.5)mm, t=9.77, P<0.001］;随访期间患者全部存活、无重要心脑血管血管事件发生。结论本研究表明FTE在TAR中可能安全有效。

关键词: 冠状动脉旁路移植术, 全动脉重建, 快通道气管拔管, 多中心, 治疗效果

Abstract: Objective To evaluate the safety and efficacy of fast-track extubation(FTE)in total arterial revascularization(TAR)in coronary bypass grafting(CABG)by a multi-center study. Methods The clinical data of all the patients who underwent TAR in 34 heart centers in China between January 2018 and May 2024 were retrospectively analyzed. The perioperative medical records and follow-up data of patients undergoing TAR with FTE(defined as extubation within 6 hours after surgery)were studied. Results Of 640 patients underwent TAR, a total of 221 patients(180 males and 41 females), with an age of(55.5±11.7)years, who accepted ETE, were included in this study. There were 171 cases of triple-vessel and 50 of double-vessel disease, with 70 of left main coronary artery lesions. Seventy-five patients had diabetes mellitus. All patients underwent TAR by on pump CABG. A total of 201 left internal mammary artery, 221 left radial artery, 200 right radial arteries, and 21 right internal mammary artery conduits were harvested to construct 612 single and 31 composite Y grafts. The number of distal anastomosis was 3.35±0.7. The time for tracheal intubation duration, ICU stay and postoperative hospital stay was(3.5±2.7)hours,(23.5±12.9)hours and(7.5±3.1)days, respectively. There was one surgical death. There was no other postoperative reintubation. Intra-aortic balloon pump was implanted in 17 patients. There were 22 patients with new-set atrial fibrillation, 11 with forearm hematoma, 13 with hypoxemia and 6 with acute renal insufficiency. No chest bone infection occurred. The follow-up duration was(54.3±7.5)months, with a follow-up rate of 90.91%. Compared to those of before operation, there was a significant improvement in left ventricular ejection fraction ［(60.0%±5.3%)vs.(55.1%±7.3%), t=11.16, P<0.001］ and an obvious decrease in left ventricular end diastolic diameter ［(51.6±2.2)mm vs.(55.0±7.5)mm, t=9.77, P<0.001］. All patients survived without major adverse cardiovascular and cerebrovascular event during follow-up. Conclusion This study suggests that FTE in TAR appears to be safe and effective.

Key words: Coronary artery bypass grafting, Total arterialization revascularization, Fast-track extubation, Multi-center, Clinical outcomes

中图分类号:

R654

国科,陈绪军,郑宝石,施超,黄克力,曹勇,陈军,吴东凯,张晓慎,罗俊辉,申林,莫绪明,杨岷,王晓武,雷印胜,田茂州,王振东,孟自力,孙忠东,李有金,陆辉辉,孟春营,高峰,陈黔苏,郭能瑞,柳德斌,张楠,林宇,陈文生,宋保国,方智,王海晨,廖晓波,徐朝军. 快通道拔管在全动脉冠脉旁路移植术的多中心临床效果[J]. 山东大学学报 (医学版), 2025, 63(5): 26-32.

GUO Ke, CHEN Xujun, ZHENG Baoshi, SHI Chao, HUANG Keli, CAO Yong, CHEN Jun, WU Dongkai, ZHANG Xiaoshen, LUO Junhui, SHEN Lin, MO Xumin, YANG Min, WANG Xiaowu, LEI Yinsheng, TIAN Maozhou, WANG Zhendong, MENG Zili, SUN Zhongdong, LI Youjin, LU Huihui, MENG Chunying, GAO Feng, CHEN Qiansu, GUO Nengrui, LIU Debin, ZHANG Nan, LIN Yu, CHEN Wensheng, SONG Baoguo, FANG Zhi, WANG Haichen, LIAO Xiaobo, XU Chaojun. Multi-center clinical outcomes of fast-track extubation in total arterial coronary bypass grafting in China[J]. Journal of Shandong University (Health Sciences), 2025, 63(5): 26-32.

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