Vermes Emmanuelle, Demaria Roland G, Martineau Raymond, Cartier Raymond, Pellerin Michel, Hébert Yves, Bouchard Denis, Pagé Pierre, Carrier Michel, Perrault Louis P
Research Centre, Montreal Heart Institute, Montreal, Quebec, Canada.
Can J Cardiol. 2004 Dec;20(14):1461-5.
Patients with diabetes constitute a high-risk population for myocardial revascularization due to extensive coronary disease.
To compare the early postoperative outcomes of patients with diabetes undergoing off-pump or on-pump coronary artery bypass surgery.
Over a four-year period (1995 to 1998), 885 diabetics were operated for primary isolated coronary bypass; 156 patients had off-pump and 729 had on-pump coronary artery bypass surgery. Patients in the off-pump group were significantly older, had a higher incidence of hypertension and renal failure, and received fewer distal anastomoses (2.7 versus 2.9, P=0.004). Postoperative myocardial infarction, reintubation and postoperative use of intra-aortic balloon pump occurred significantly more frequently in the off-pump group (10.3% versus 5.5%, P=0.04; 8.3% versus 3.6%, P=0.03; 7.7% versus 1.5%, P=0.0001, respectively). Multivariate analysis revealed that type of surgery was an independent predictor of these complications, which occurred 1.9, 2.7 and 7.9 times more often, respectively, in the off-pump group. The 30-day mortality rate was not significantly different between the groups.
Off-pump coronary artery bypass surgery is associated with an increased early postoperative morbidity in patients with diabetes and, thus, should be used with caution.
由于广泛的冠状动脉疾病，糖尿病患者是心肌血运重建的高危人群。
比较接受非体外循环或体外循环冠状动脉搭桥手术的糖尿病患者的术后早期结局。
在四年期间（1995年至1998年），885例糖尿病患者接受了初次单纯冠状动脉搭桥手术；156例患者接受非体外循环冠状动脉搭桥手术，729例患者接受体外循环冠状动脉搭桥手术。非体外循环组患者年龄显著更大，高血压和肾衰竭发生率更高，远端吻合数量更少（2.7比2.9，P=0.004）。非体外循环组术后心肌梗死、再次插管和术后主动脉内球囊反搏的使用明显更频繁（分别为10.3%比5.5%，P=0.04；8.3%比3.6%，P=0.03；7.7%比1.5%，P=0.0001）。多变量分析显示手术类型是这些并发症的独立预测因素，在非体外循环组中这些并发症的发生频率分别高出1.9、2.7和7.9倍。两组的30天死亡率无显著差异。
非体外循环冠状动脉搭桥手术与糖尿病患者术后早期发病率增加相关，因此应谨慎使用。
