Objective:The perioperative and early follow-up data of the simultaneous hybrid CAS+ OPCABG and sequential CAS+ OPCABG were compared to evaluate the safety and efficacy of the simultaneous CAS+ OPCABG.Methods:A total of 26 patients with coronary heart disease complicated with carotid artery stenosis received CAS plus OPCABG hybrid surgery in our hospital from January 2020 to July 2021, among which 12 patients received simultaneous CAS+ OPCABG and 14 patients received staged sequential CAS+ OPCABG.The perioperative and postoperative follow-up data of 3 months were compared and analyzed.Results:There were no significant differences in the operation time, drainage on the first day after surgery, ventilator assisted time and ICU time between the two groups.The amount of intraoperative blood loss in the simultaneous group was more than that in the staged group, but no secondary thoracotomy occurred in both groups. The number of days in hospital after operation was significantly less in the simultaneous group. There was 1 case of perioperative cerebral infarction and 1 case of myocardial infarction in the staged group, but there was no statistical difference between the two groups. There was no new cerebral infarction in the two groups, carotid artery ultrasound stent was unobstructed, and there was no statistical difference in cardiac function grading and left ventricular ejection fraction 3 months after operation.Conclusion:Simultaneous CAS+ OPCABG surgery is safe and feasible, it is recommended as the first choice especially for patients with severe myocardial ischemiaor severe left main artery disease caused.How to reduce the risk of bleeding and alleviat carotid sinus reflex are major issues that need to be concerned.

目的:分析老年冠心病患者接受冠状动脉旁路移植(CABG)术的临床特征和疗效.方法:回顾性分析2015年1月至2019年12月,北京安贞医院微创心脏外科中心治疗的787例老年冠心病患者临床资料,并进行随访,包括主要不良心脑血管事件(MACCE)、心源性死亡、心肌梗死、心力衰竭、中风和血运重建,以及患者术后服药情况.结果:患者平均随访时间为3.1年.随访结果显示患者2、4、6和8年无心源性死亡事件的生存率分别为97.3％、94.2％、93.9％、89.0％.发生MACCE(6.4％)、心源性死亡3.9％、心肌梗死0.3％、心力衰竭0.4％,部分患者接受了 PCI再血管化治疗(0.6％).患者冠心病二级预防药服用率较低,尤其是他汀类药物(63.8％)和阿司匹林(89.8％).结论:老年冠心病患者接受非体外CABG术的中远期疗效较好.老年患者术后服药依从性较差,需要定期指导合理用药.

目的 探讨微创冠状动脉(冠脉)旁路移植术(minimal invasive coronary artery bypass grafting,MICSCABG)手术时间的变化学习曲线及其对围术期临床效果的影响.方法 纳入本中心2012年3月至2020年11月212例连续由同一位外科医生完成的不停跳MICS CABG患者,其中单支搭桥59例为单支组,男52例、女7例,平均年龄(62.89±8.27)岁;多支搭桥153例为多支组,男138例、女15例,平均年龄(59.80±9.22)岁.分别绘制两组手术时间-手术序列散点图,通过累计求和分析法(cumulative summation,CUSUM)量化手术时间并绘制学习曲线,计算拟合公式和学习曲线拐点.比较每组学习曲线拐点前后病例手术资料和术后30 d内主要临床结局事件.结果 212例MICSCABG患者无死亡、围术期心肌梗死及脑卒中,无中转体外循环及二次开胸.两组手术时间随着手术例数的累计均逐渐下降并趋于稳定,学习曲线符合三次方拟合公式:单支组拟合方程CUSUM(x手术序号)=1.93+93.45×x-2.33 ×x2+0.01 ×x3,P=0.000,拟合度R2=0.986,学习曲线拐点为27例;多支组拟合方程CUSUM(x手术序号)=y=2.87+1.15×x-1.29×x2+3.463×x3,P=0.000,拟合度R2=0.993,手术例数累计到59例时达到学习曲线拐点.两组病例数据进行跨越学习曲线前后数据对比,除手术时间差异外,30 d内主要临床结局事件(死亡率、急性心肌梗死、脑卒中、围术期输血率)及呼吸机带管、监护室滞留、住院时间、出院生活能力评分差异均无统计学意义.结论 不停跳MICS CABG平均手术时间符合三次方曲线,学习曲线由微创单支过渡到多支搭桥.学习阶段进入成熟阶段需要积累一定的手术例数,合理的手术流程和质量控制措施可确保学习阶段手术的安全性.

目的 对比微创冠状动脉旁路移植术(minimally invasive coronary artery bypass grafting,MICABG)和常规开胸搭桥围术期临床效果,分析MICABG的有效性和安全性.方法 收集2017年1月至2020年9月北京安贞医院单医疗组接受不停跳冠状动脉旁路移植术患者共543例,其中MICABG161例[微创组,男143例、女18例,年龄(60.08±9.21)岁],正中开胸382例[常规组,男284例、女98例,年龄(61.68±8.81)岁].用倾向性评分匹配后两组各143例患者,总结并分析两组围术期资料.结果 微创组患者无死亡、围术期心肌梗死及脑卒中.与常规组相比,微创组手术时间长[(296.36±89.41)min vs.(217.80±50.63)min,P=0.000]、搭桥数量少[(2.86±1.03)支vs.(3.17±0.78)支,P=0.005]、术后住院时间短[(6.29±1.46)d vs.(6.78±2.61)d,P=0.031]、术后第1d引流量少[(339.57±180.63)mL vs.(441.92±262.63)mL,P=0.001]及正性肌力药使用率低(9.09％ vs.26.57％,P=0.001).两组术后监护室滞留时间、呼吸机辅助时间、输血率、二次开胸率、机械辅助设备使用时间差异无统计学意义.结论 采用合理的临床策略完全可以使MICABG的总体安全性不低于常规搭桥手术,并具有出血量少、正性肌力药用量小的优势,脑部并发症的发生率也可得到满意控制.