- 期刊
Comparison of On-pump and Off-pump CABG in Hemodialysis Patients
使用體外循環與不使用體外循環冠狀動脈繞道手術在透析患者之比較
摘要
背景：冠狀動脈疾病一直是腎衰竭病人主要死因之一，而尿毒症病患接受使用體外循環的傳統冠狀動脈繞道手術危險性也比正常人高。近年來，心臟不停跳的技術廣泛被使用在冠狀動脈繞道手術上，已有許多報告指出其結果比傳統冠狀動脈繞道手術更好，特別在高危險群的病患上。在本篇文章中，我們將比較洗腎患者使用體外循環與不使用體外循環冠狀動繞道手術的結果，來找出一種更好、更安全的治療方式。 方法：從1999年1月至2002年4月，共有25個尿毒症患者接受冠狀動脈繞道手術，其中14個病人使用體外循環，11個病人則不使用體外循環。 結果：在這兩類病人中，術前的比較並沒有明顯的差異，包括性別、年紀、洗腎時間、術前心臟功能。但其手術結果，使用體外循環與不使用體外循環卻有明顯的差異。無論在手術時間、術後心臟功能恢復、術後出血及輸血量、拔管時間、加護病房停留時間、總住院天數、術後併發症、甚至在經濟效益上，尿看症患者接不使用體外循環冠狀動脈繞道手術都有較好的結果。這使我們在治療腎衰竭病人的冠狀動脈疾病能採取更積極、更有效的的方式。 結論：從我們經驗顯示：不使用體外循環冠狀動脈繞道手術將提供透析病人在罹患冠狀動脈疾病時，有一個更好、更安全的治療方式。
並列摘要
Objectives: Coronary artery disease is the primary cause of death among patients with end-stage renal disease worldwide. Conventional coronary arterial bypass grafting (CABG) under cardiopulmonary bypass (CPB) is still a high-risk procedure. In the past few years, off-pump coronary artery bypass grafting has afforded an alternative way to improve the surgical result. The authors report their experience of performing conventional CABG and off-pump CABG in regular dialysis patients. Methods: From January 1999 to April 2002, we compared retrospectively 25 consecutive uremia patients undergoing CABG. Group I: 14 patients undergoing conventional CABG, and Group II: 11 patients undergoing off-pump CABG. We analyzed the data between these two procedures including age, gender, pre-operative characteristics, intra-operative blood transfusions, operative time, post-operative inotropic use, post-operative bleeding (drainage amount), extubation time, intensive care unit (ICU) stay, total hospital stay, and complications. Results: There were statistically significant differences between the two groups. Off-pump CAB procedures resulted in significantly (p ＜ 0.05) lower mean operative time: 260 (200-235) vs. 307.5 (215-502) min, post-operative potassium value: 4 (3.4-5.2) mmol/L vs. 5.05(3.9-6.2) mmol/L, post-operative dopamine: 2.52 (0-5.4) ug/min/kg vs. 5.35 (2.53-15.2) ug/min/kg and dobutamin 0 ug/min/kg vs. 2.8(0-10) ug/min/kg use, ICU stay: 1 (1-5) days vs. 3 (1-24) days, extubation time: 8 (1-456) hours vs. 25.67 (6-543) hours, post-operative bleeding: 610 (375-1135) mL vs. 1443 (335-3877) mL, time of removal of drainage tube: 3.0 (2-4) days vs. 4.5 (3-9) days, postoperative blood transfusion: 0(0-500) mL vs. 500(0-200) mL. Conclusions: Our preliminary experience demonstrates that short-term outcomes in uremia patents undergoing off-pump CABG are better than conventional CABG. Off-pump CABG supplies a safe and effective method to treat uremia patients with coronary artery disease.