多支动脉桥应用不增加低心功能冠心病患者围手术期及近中期风险：单治疗组3年随访结果

doi:10.12122/j.issn.1673-4254.2025.02.04

摘要/Abstract

摘要：

目的比较多支动脉桥和单支动脉桥非体外循环下冠状动脉旁路移植术（OPCABG）在左心功能降低患者中的围手术期及近中期结果。方法选取从2018年1月~2021年12月在郑州大学第一附属医院单治疗组行非体外循环冠状动脉旁路移植术且左室射血分数小于50%的患者86例，其中行多支动脉桥OPCABG 22例（多支动脉桥组），行单支动脉桥OPCABG 64例（单支动脉桥组）。收集整理所有入选患者术前、术中及围手术期临床资料。术后随访29.28±14.84月，比较两组患者围手术期及随访结果，Logistic回归分析两组患者术后主要不良心血管事件（MACE）发生影响因素，Kaplan-Meier分析OPCABG术后无MACE生存率。结果两组患者术前基线资料中，年龄差异有统计学意义（P<0.05），多支动脉桥组患者年龄小于单支动脉桥组，其余资料差异均无统计学意义（P>0.05），两组患者围手术期死亡率、术后24 h胸腔引流量、监护室滞留时间、气管插管时间、术后新发房颤差异均无统计学意义（P>0.05）。多支动脉桥组与单支动脉桥组相比，术后低血压状态发生率较高（34.78% vs 11.54%，P=0.009）。随访数据中患者MACE的发生率及超声数据均无明显差异（P>0.05）。Logistic回归分析女性（OR：0.191，95% CI：0.049-0.075）、肌酐（OR：1.016，95% CI：1.000-1.033）是患者术后MACE发生的影响因素，Kaplan-Meier分析显示两组患者在随访期内无MACE发生率差异无统计学意义。结论多支动脉桥OPCABG对于左心功能不全的患者并不增加围手术期严重并发症，且不增加近中期MACE风险。

关键词: 冠状动脉旁路移植术, 非体外循环, 多支动脉移植物, 左室功能降低

Abstract:

Objective To compare perioperative and mid-term results of multiple versus single arterial off-pump coronary artery bypass grafting (OPCABG) in patients with impaired left ventricular function. Methods This study was conducted among 86 patients with a left ventricular ejection fraction (LVEF) <50%, who underwent OPCABG at our hospital between January, 2018 and December, 2021. Of these patients, 22 underwent OPCABG with multiple arterial grafts (multiple graft group) and 64 received a single arterial graft in OPCABG (single graft group). The preoperative, intraoperative, and perioperative data were collected, and the patients were followed up for a mean of 29.28±14.84 months. The perioperative outcomes and follow-up results of the patients were compared, and the factors influencing major adverse cardiovascular events (MACE) were identified using logistic regression. Kaplan-Meier analysis was used to compare the postoperative survival rate without MACE. Results The patients in multiple graft group had a significantly younger age than those in single graft group (P<0.05), but the other baseline data were similar between the two groups (P>0.05). Perioperative mortality, 24-h postoperative drainage volume, length of ICU stay, intubation time, and the incidence of new-onset atrial fibrillation were all similar between the two groups (P>0.05), but the rate of postoperative hypotension was significantly higher in multiple graft group (34.78% vs 11.54%, P=0.009). No significant differences were found in the incidence of MACE or echocardiographic data during the follow-up. Logistic regression identified the female sex (OR: 0.191, 95% CI: 0.049-0.075) and creatinine level (OR: 1.016, 95% CI: 1.000-1.033) as factors affecting postoperative MACE occurrence. Kaplan-Meier analysis showed no significant difference in MACE-free survival rate between the two groups. Conclusion OPCABG with multiple arterial grafts does not increase severe perioperative complications or the risk of mid-term MACE in patients with impaired left ventricular function.

Key words: coronary artery bypass grafting, off-pump, multiple arterial graft, reduced left ventricular function

李子濡, 白晟玮, 张俭, 徐昊, 臧素华, 张新. 多支动脉桥应用不增加低心功能冠心病患者围手术期及近中期风险：单治疗组3年随访结果[J]. 南方医科大学学报, 2025, 45(2): 239-244.

Ziru LI, Shengwei BAI, Jian ZHANG, Hao XU, Suhua ZANG, Xin ZHANG. Multiple arterial grafts does not increase perioperative or short- to medium-term risks of postoperative MACE in patients with impaired left ventricular function: 3-year follow-up results[J]. Journal of Southern Medical University, 2025, 45(2): 239-244.

图/表 5

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Variable	Multiple arterial group (n=22)	Single arterial group (n=64)	t/Z/χ²	P
Gender [n (%)]
Male	20 (90.91)	49 (76.56)	2.411	0.121
Female	2 (9.09)	15 (23.44)	2.411	0.121
Age (year)	54.05±6.31	61.41±7.83	-3.982	<0.001
Hypertension [n (%)]	9 (40.91)	28 (43.75)	0.054	0.816
Stroke [n (%)]	2 (9.09)	5 (7.81)	0.035	0.852
Diabetes [n (%)]	7 (31.82)	25 (39.06)	0.368	0.544
PCI [n (%)]	3 (13.64)	8 (12.50)	0.019	0.891
AST (U/L)	20.00 (17.00, 28.75)	22.00 (16.00, 38.75)	-0.228	0.820
SCr (μmol/L)	80.50 (69.00, 101.50)	74.00 (63.50, 88.50)	-1.802	0.072
Albumin (g/L)	42.40 (39.05, 44.65)	40.55 (37.80, 43.45)	-1.599	0.110
LVEF (%)	47.50 (36.75, 51.25)	47.00 (40.00, 51.00)	-0.149	0.882
LVEDD (mm)	54.23±6.48	55.95±7.13	-1.001	0.320
LVESV (mL)	91.00 (62.00, 118.50)	93.00 (72.00, 121.00)	-0.597	0.550
PASP (mmHg)	21.00 (20.00, 23.00)	22.50 (21.00, 29.75	-1.844	0.065
AST: Aspartate transaminase; SCr: Serum creatinine; LVEF: Left ventricular ejection fraction; LVEDD: Left ventricular end-diastolic diameter; LVESV: Left ventricular end-systolic volume; PASP: pulmonary artery systolic pressure.

Variable	Multiple arterial group (n=22)	Single arterial group (n=64)	t/Z/χ²	P
Gender [n (%)]
Male	20 (90.91)	49 (76.56)	2.411	0.121
Female	2 (9.09)	15 (23.44)	2.411	0.121
Age (year)	54.05±6.31	61.41±7.83	-3.982	<0.001
Hypertension [n (%)]	9 (40.91)	28 (43.75)	0.054	0.816
Stroke [n (%)]	2 (9.09)	5 (7.81)	0.035	0.852
Diabetes [n (%)]	7 (31.82)	25 (39.06)	0.368	0.544
PCI [n (%)]	3 (13.64)	8 (12.50)	0.019	0.891
AST (U/L)	20.00 (17.00, 28.75)	22.00 (16.00, 38.75)	-0.228	0.820
SCr (μmol/L)	80.50 (69.00, 101.50)	74.00 (63.50, 88.50)	-1.802	0.072
Albumin (g/L)	42.40 (39.05, 44.65)	40.55 (37.80, 43.45)	-1.599	0.110
LVEF (%)	47.50 (36.75, 51.25)	47.00 (40.00, 51.00)	-0.149	0.882
LVEDD (mm)	54.23±6.48	55.95±7.13	-1.001	0.320
LVESV (mL)	91.00 (62.00, 118.50)	93.00 (72.00, 121.00)	-0.597	0.550
PASP (mmHg)	21.00 (20.00, 23.00)	22.50 (21.00, 29.75	-1.844	0.065
AST: Aspartate transaminase; SCr: Serum creatinine; LVEF: Left ventricular ejection fraction; LVEDD: Left ventricular end-diastolic diameter; LVESV: Left ventricular end-systolic volume; PASP: pulmonary artery systolic pressure.

Variable	Multiple arterial group (n=22)	Single arterial group (n=64)	t/Z/χ²	P
Number of grafts	3.73±0.94	3.69±0.71	0.208	0.835
Heparin-protamine time (h)	173.85±40.82	152.47±43.57	1.937	0.056
24-hour postoperative drainage volume (mL)	675.68±258.96	643.88±270.17	0.481	0.632
Reoperation [n (%)]	1 (4.55)	1 (1.56)	0.634	0.426
Postoperative dialysis [n (%)]	0 (0.00)	1 (1.56)	0.344	0.558
In-hospital mortality[n (%)]	1 (4.55)	1 (1.56)	0.634	0.426
Postoperative intubation time (h)	20.90 (16.45, 26.20)	20.80 (16.20, 22.00)	-0.678	0.498
ICU length of stay (h)	60.85 (36.65, 67.63)	60.25 (41.00, 67.88)	-0.361	0.718
Postoperative hypotension [n (%)]	8 (36.36)	9 (12.50)	5.568	0.018
New-onset Atrial Fibrillation [n (%)]	1 (4.55)	10 (15.63)	2.160	0.142
Postoperative in-hospital time (d)	10.00 (8.00, 14.00)	11.00 (9.00, 15.00)	-1.311	0.190
LVEF (%)	50.32±8.94	48.81±7.44	0.777	0.440
LVEDD (mm)	49.82±5.59	51.73±6.43	-1.239	0.219
LVESV (mL)	68.55±30.13	73.68±41.18	-0.536	0.593
PASP (mmHg)	23.00 (21.00, 28.50)	21.00 (21.00, 28.75)	-0.032	0.975

Variable	Multiple arterial group (n=22)	Single arterial group (n=64)	t/Z/χ²	P
Number of grafts	3.73±0.94	3.69±0.71	0.208	0.835
Heparin-protamine time (h)	173.85±40.82	152.47±43.57	1.937	0.056
24-hour postoperative drainage volume (mL)	675.68±258.96	643.88±270.17	0.481	0.632
Reoperation [n (%)]	1 (4.55)	1 (1.56)	0.634	0.426
Postoperative dialysis [n (%)]	0 (0.00)	1 (1.56)	0.344	0.558
In-hospital mortality[n (%)]	1 (4.55)	1 (1.56)	0.634	0.426
Postoperative intubation time (h)	20.90 (16.45, 26.20)	20.80 (16.20, 22.00)	-0.678	0.498
ICU length of stay (h)	60.85 (36.65, 67.63)	60.25 (41.00, 67.88)	-0.361	0.718
Postoperative hypotension [n (%)]	8 (36.36)	9 (12.50)	5.568	0.018
New-onset Atrial Fibrillation [n (%)]	1 (4.55)	10 (15.63)	2.160	0.142
Postoperative in-hospital time (d)	10.00 (8.00, 14.00)	11.00 (9.00, 15.00)	-1.311	0.190
LVEF (%)	50.32±8.94	48.81±7.44	0.777	0.440
LVEDD (mm)	49.82±5.59	51.73±6.43	-1.239	0.219
LVESV (mL)	68.55±30.13	73.68±41.18	-0.536	0.593
PASP (mmHg)	23.00 (21.00, 28.50)	21.00 (21.00, 28.75)	-0.032	0.975

Variable	Multiple arterial group (n=22)	Single arterial group (n=64)	χ²	P
MACE	4(18.18)	14(21.88)	0.138	0.710
Cardiac death	0(0.00)	2(3.13)	1.198	0.274
Recurrent angina	3(13.64)	7(10.94)	0.113	0.737
Recurrent myocardial infarction	0(0.00)	2(3.13)	1.198	0.274
Revascularization therapy	0(0.00)	1(1.56)	0.595	0.441
Heart failure readmission	3(13.64)	9(14.06)	0.002	0.960
MACE: Major adverse cardiovascular events.