摘要目的 比较心肺转流不停跳冠状动脉旁路移植术(0BCAB)与非体外循环冠状动脉旁路移植术(0PCAB)治疗冠心病合并左心室功能不全(射血分数≤35%)的效果.方法 2010年1月至2014年12月共有216例LVEF≤35%的冠心病合并左心室功能不全(射血分数≤35%)的患者在复旦大学附属中山医院心外科接受首次、单纯冠状动脉旁路移植术,其中88例采用0BCAB,128例采用0PCAB.采用独立样本t检验、秩和检验、χ2检验、Fisher精确检验比较两组手术结果.结果 两组患者术前资料基本匹配.0BCAB组和0PCAB组分别有3例(3.4%)和6例(4.7%)死亡.术后两组患者的射血分数均明显改善[0BCAB组:术前(31.0± 2.8)%比术后(35.6± 2.9)%,t=10.61,P=0.000;0PCAB组:术前(31.0±2.9)% 比术后(34.8±3.3)%,t=9.68,P=0.000],0BCAB组改善程度高于0PCAB组[(4.7±0.2)%比(3.6±0.3)%,t=29.53,P=0.000].0BCAB组较0PCAB组移植血管更多[(3.7±0.8)支比(2.8±0.6)支,t=9.442,P=0.000],术后24 h引流量0BCAB组较0PCAB组明显增多[(715±187)ml比(520±148)ml,t=8.544,P=0.000].结论 0BCAB可取得更充分的完全再血管化,从而改善患者术后左心室功能,可选择性应用于冠心病合并左心室功能不全患者.

abstractsObjective To evaluate the impacts of an on?pump beating?heart versus an off?pump coronary artery bypass grafting(CABG)technique for surgical revascularization on the early clinical outcomes in patients with a left ventricular ejection fraction(EF)of 35% or less.Methods A total of 216 consecutive patients with an echocardiographic estimated EF of 35% or less who underwent non?emergency,primary,isolated CABG from January 2010 to December 2014 at Department of Cardiovascular Surgery,Zhongshan Hospital,Fudan University were included in this study and were divided into either an 0BCAB group(patients who received on?pump beating?heart CABG surgery, n=88)or an 0PCAB group (patients who received off?pump CABG surgery,n=128). The early clinical outcomes were investigated and compared. The outcomes were compared between groups by t?test, χ2 test or Fisher′s exact test, when appropriate. Results No significant differences emerged between the two groups in baseline characteristics of the entire cohort except for more patients with diabetes and a larger left ventricular endo?diastolic diameter in the 0BCAB group. Patients in the 0BCAB group compared to the 0PCAB group had a similar in?hospital mortality(3.4% vs. 4.7%,P= 0.741). Mean EF, as measured preoperatively and early postoperatively (before discharge),significantly improved from(31.0±2.8)% to(35.6±2.9)%(t=10.61, P=0.000) in the 0BCAB group and from(31.0 ± 2.9)% to(34.8 ± 3.3)%(t=9.68, P=0.000)in the 0PCAB group,respectively. The improvement of mean LVEF in the 0BCAB group was significantly higher than that in the 0PCAB group((4.7±0.2)% vs.(3.6±0.3)%, t=29.53, P=0.000). Patients in the 0BCAB group compared to the 0PCAB group had a significant higher early postoperative EF((35.6± 2.9)% vs. (34.8±3.3)%, t=1.892,P=0.034)but shared a similar baseline EF((31.0 ± 2.8)% vs.(31.0 ± 2.9)%,t=0.012, P=0.930). Patients in the 0BCAB group compared to the 0PCAB group received a greater number of grafts and an increased amount of drainage during the first 24 h(3.7±0.8 vs. 2.8±0.6, t=9.442,P=0.000;(715± 187)ml vs.(520± 148)ml, t=8.544, P=0.000, respectively), without evidence of worse in?hospital mortality or major postoperative morbidity. Conclusion The on?pump beating?heart technique may be an acceptable alternative to the off?pump technique for surgical revascularization in patients with an estimated EF of 35% or less.