Srinivasan Arun K, Grayson Antony D, Fabri Brian M
Department of Cardiothoracic Surgery, The Cardiothoracic Centre Liverpool, Liverpool, United Kingdom.
Ann Thorac Surg. 2004 Nov;78(5):1604-9. doi: 10.1016/j.athoracsur.2004.04.080.
Diabetic patients are recognized as being at high risk for adverse outcomes after coronary artery bypass grafting. We evaluated our outcomes in diabetic patients to compare the effect of off-pump with on-pump coronary revascularization.
Between April 1997 and September 2002, 951 consecutive diabetic patients underwent isolated coronary artery bypass grafting. A total of 186 (19.6%) of these patients had off-pump coronary procedures. Multivariate logistic regression was used to assess the effect of off-pump coronary procedures on adverse in-hospital outcomes, while adjusting for patient and disease characteristics by constructing a propensity score from core patient characteristics. The propensity score was the probability of receiving off-pump coronary operation, with a C-statistic of 0.81, and was included along with the comparison variable in a multivariable analysis of outcome. All analysis was performed retrospectively.
Off-pump patients were more likely to be obese (p = 0.032), have left main stem stenosis (p = 0.034), and have undergone prior cardiac operation (p = 0.027). The off-pump group had fewer patients with three-vessel disease compared with the on-pump group. After risk adjusting with propensity score, off-pump patients had a significantly lower incidence of stroke (adjusted odds ratio 0.15; p = 0.039) and renal failure (adjusted odds ratio 0.38; p = 0.036). Off-pump patients also required less blood transfusion (p < 0.001) and had shorter lengths of stay (p < 0.001).
Off-pump coronary operation in diabetic patients significantly reduced postoperative morbidity and length of stay compared with on-pump coronary operation, although no in-hospital survival difference was noted between the two groups.
糖尿病患者被认为是冠状动脉旁路移植术后出现不良后果的高危人群。我们评估了糖尿病患者的治疗结果，以比较非体外循环与体外循环冠状动脉血运重建的效果。
在1997年4月至2002年9月期间，951例连续的糖尿病患者接受了单纯冠状动脉旁路移植术。其中共有186例（19.6%）患者接受了非体外循环冠状动脉手术。采用多因素逻辑回归分析评估非体外循环冠状动脉手术对住院期间不良结局的影响，同时通过根据核心患者特征构建倾向评分来调整患者和疾病特征。倾向评分是接受非体外循环冠状动脉手术的概率，C统计量为0.81，并与比较变量一起纳入结局的多变量分析中。所有分析均为回顾性分析。
非体外循环患者更易肥胖（p = 0.032）、有左主干狭窄（p = 0.034）且曾接受过心脏手术（p = 0.027）。与体外循环组相比，非体外循环组三支血管病变的患者较少。在通过倾向评分进行风险调整后，非体外循环患者的中风发生率显著较低（调整后的优势比为0.15；p = 0.039）和肾衰竭发生率较低（调整后的优势比为0.38；p = 0.036）。非体外循环患者也需要较少的输血（p < 0.001）且住院时间较短（p < 0.001）。
与体外循环冠状动脉手术相比，糖尿病患者的非体外循环冠状动脉手术显著降低了术后发病率和住院时间，尽管两组之间未观察到住院期间生存率的差异。
