不接触获取大隐静脉技术应用于非体外循环冠状动脉旁路移植术的早期临床效果OA北大核心CSTPCD
Early clinical outcomes of no-touch saphenous vein harvesting technique applied to off-pump coronary artery bypass grafting
目的:评价不接触获取技术与常规获取技术应用于非体外循环冠状动脉旁路移植术的早期临床效果.方法:回顾性分析南京医科大学第一附属医院心脏大血管外科2020年7月一2022年7月行非体外循环冠状动脉旁路移植术的120例患者的临床资料,其中50例采用不接触获取技术(No-touch组),70例采用常规获取技术(CVH组).观察指标包括手术时间、静脉桥血管数量、静脉桥血管平均流量、机械通气时间、ICU监护时间和术后下肢切口愈合不良、术后急性肾损伤等并发症,以及随访1年后的心脏超声指标和冠状动脉CT血管成像结果.结果:两组患者手术时间、静脉桥血管数量、静脉桥血管平均流量、机械通气时间、ICU监护时间等比较差异均无统计学意义(P＞0.05).No-touch组术后主动脉内球囊反搏(intra-aortic balloon pump,IABP)支持5例,下肢切口愈合不良2例,术后突发心血管事件1例.CVH组术后IABP支持2例,术后急性肾损伤1例.两组均无二次开胸探查和二次气管插管情况,且术后各并发症发生率比较差异无统计学意义(P＞0.05).两组患者术后1年心脏超声指标差异无统计学意义(P＞0.05).No-touch组术后1年静脉桥血管闭塞率低于CVH组(P＜0.05).结论:与常规获取技术相比,在非体外循环冠状动脉旁路移植手术中采用不接触技术获取大隐静脉不增加手术风险,术后1年桥血管通畅率较高.
Objective:To evaluate the early clinical outcomes of no-touch harvesting technique and conventional harvesting technique applied to off-pump coronary artery bypass grafting.Methods:The clinical data of 120 patients who underwent off-pump coronary artery bypass grafting from July 2020 to July 2022 in the Department of Cardiovascular Surgery of the First Affiliated Hospital of Nanjing Medical University were retrospectively analyzed,of which 50 cases used no-touch harvesting technique(No-touch group)and 70 cases used conventional harvesting technique(CVH group).Observation indexes included operation time,number of vein graft,average flow rate of vein graft,ventilation time,ICU stay,postoperative complications such as poor healing of leg wound and postoperative acute kidney injury,as well as echocardiographic indexes and coronary CT angiography results after 1 year of follow-up.Results:There was no statistically significant difference in operation time,number of vein graft,average flow rate of vein graft,ventilation time and ICU stay between the two groups(P＞0.05).In the No-touch group,there were 5 cases of intra-aortic balloon pump(IABP)support,2 cases of poor healing of leg wound,and 1 case of postoperative cardiac event.In the CVH group,there were 2 cases of postoperative IABP support and 1 case of postoperative acute kidney injury.There were no cases of reoperation and reintubation in the two groups,and the difference in the incidence of postoperative complications was not statistically significant(P＞0.05).There was no statistically significant difference in the postoperative echocardiographic indexes between the two groups at 1 year after surgery(P＞0.05).The rate of vein graft occlusion in the No-touch group was lower than that in the CVH group at 1 year after surgery,and the difference between the two groups was statistically significant(P＜0.05).Conclusion:Compcued with conventional harvesting technique,the use of no-touch harvesting technique for saphenous vein harvesting in off-pump coronary artery bypass grafting does not increase the surgical risk,and the patency rate of vein graft is high at 1 year after surgery.
韩立翔;段书朋;李芝;孙浩亮;耿乐;魏磊
南京医科大学第一附属医院心脏大血管外科,江苏 南京 210029
临床医学
不接触获取技术大隐静脉冠状动脉旁路移植术
no-touch harvestingsaphenous veincoronary artery bypass grafting
《南京医科大学学报（自然科学版）》 2024 (005)
649-654 / 6
江苏省科技厅重点研发计划(BE2023081)
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