- 期刊
Is Performing Off-Pump Coronary Artery Bypass More Stressful for the Surgical Team than Conventional Coronary Artery Bypass
不停跳冠狀動脈繞道手術較傳統冠狀動脈繞道手術帶給手術團隊的壓力較大嗎？
摘要
背景：雖然不停跳冠狀動脈繞道手術(OPCAB)日趨普遍，但許多心臟外科醫師認爲此手術技術太困難，而且心理壓力太大，因此不願採用。我們做了這個研究來證實是否果眞如此。 方法：這是個前瞻非隨機研究，從2005年4月到9月在一個郊區區域醫院執行。我們用移動式心電圖來監測冠狀動脈手術中心臟外科醫師及體外循環師的心跳，術中各手術步驟及其相對應之心跳都持續記錄下來。心跳上升被視爲手術團隊心理壓力增加。共有14次手術被記錄。 結果：14位病患接受常規冠狀動脈繞道手術，八位接受不停跳，六位接受傳統冠狀動脈繞道手術。從心電圖記錄可知，平時外科醫師的心跳就比體循師快。不論是外科醫師或體循師，在執行冠狀動脈吻合時，心跳均較手術整體平均值快，但在兩組間（不停跳或傳統冠狀動脈繞道）並無差異。這結果顯示不管是心臟外科醫師或是體循師，在不停跳或傳統冠狀動脈繞道手術時之心理壓力並無不同。 結論：執行不停跳冠狀動脈繞道手術較之傳統手術時之手術團隊心理壓力並無較大。選擇適當的病患及適當的手術團隊訓練是重要的。
並列摘要
Objective: Though off-pump coronary artery bypass (OPCAB) is getting more popular today, some cardiac surgeons assume that it's too technically demanding and mentally stressful to perform it. In order to find out if OPCAB is more stressful than conventional coronary artery bypass (CCAB) for the surgical team, we conducted this study. Materials and Methods: This was a prospective non-randomized study, and was conducted in a rural community hospital from April to September 2005. We used ambulatory ECG monitoring to record the surgeon's and the perfusionist's heart rate during coronary artery bypass operations. Each procedure corresponding to the change of the heart rate was recorded simultaneously for later analysis. The increase of heart rate while performing a specific procedure was considered an elevation of the mental stress. Heart rate data and patient data from 14 operations were collected and analyzed. Results: Fourteen patients undergoing elective coronary bypass surgery were enrolled. All patients were assigned to either OPCAB or CCAB according to the surgeon's clinical judgment. Eight patients were assigned to OPCAB, and 6 to CCAB. No patient was converted to the other procedures. The surgeon's heart rate was intrinsically higher than the perfusionist's, reflecting mainly the interpersonal difference. The heart rates of both the surgeon and the perfusionist were slightly higher than average while performing the coronary anastomoses. No difference of heart rate of either the surgeon or the perfusionist could be observed, no matter whether they were performing the anterior, the lateral, or the inferior anastomoses between these two groups (OPCAB and CCAB) or during the whole procedure. These results imply that both the surgeon and the perfusionist experienced the same level of mental stress either performing CCAB or OPCAB. Conclusions: Performing OPCAB is not more stressful for the surgical team than CCAB. Careful patient selection, as well as appropriate training and familiarity with the procedures for the surgical team are advised.