Narayan P, Caputo M, Jones J, Al-Tai S, Angelini G D, Wilde P
Bristol Heart Institute, Bristol Royal Infirmary, Bristol, UK.
Clin Radiol. 2005 Jun;60(6):693-9. doi: 10.1016/j.crad.2004.10.012.
A variety of chest radiograph abnormalities are recognized after coronary artery bypass grafting (CABG). This study analyzes the appearance of preoperative and postoperative chest radiographs in two groups of patients undergoing myocardial revascularization with or without the use of cardiopulmonary bypass (CPB).
Chest radiographs (preoperative and at 1 day, 6 days and 6 to 8 weeks post operatively) were analyzed according to a detailed protocol in cases of conventional CABG on CPB (n=60) or off-pump coronary artery bypass (OPCAB) (n=60) surgery. On each film 17 different major potential postoperative abnormalities were analyzed.
Clinical findings were similar in the two groups. Patients undergoing OPCAB surgery had decreased blood loss, decreased red cell and platelet transfusion, significantly lower intubation time and required less postoperative inotropic support compared with patients undergoing CPB. The CPB group had a significantly higher incidence of left band atelectasis than the OPCAB group (37.6% vs 17.5%, p=0.01) at 6 days postoperatively. There was no other statistically significant difference in any of the 16 remaining major chest radiograph findings between the two groups.
Although OPCAB surgery is associated with improved clinical outcome compared with conventional CABG surgery, the analysis of postoperative chest radiographs demonstrated only a minor benefit as shown by a reduced degree of left band atelectasis in the OPCAB group.
冠状动脉旁路移植术（CABG）后可发现多种胸部X线异常。本研究分析了两组接受心肌血运重建术的患者术前和术后胸部X线片的表现，这两组患者分别采用或未采用体外循环（CPB）。
根据详细方案，对接受CPB的传统CABG手术患者（n = 60）或非体外循环冠状动脉搭桥术（OPCAB）患者（n = 60）的胸部X线片（术前、术后1天、6天和6至8周）进行分析。在每张片子上分析17种不同的主要潜在术后异常情况。
两组的临床结果相似。与接受CPB的患者相比，接受OPCAB手术的患者失血量减少，红细胞和血小板输注量减少，插管时间显著缩短，术后所需的强心支持也更少。术后6天时，CPB组左肺不张的发生率显著高于OPCAB组（37.6%对17.5%，p = 0.01）。两组其余16项主要胸部X线表现中，无其他具有统计学意义的差异。
虽然与传统CABG手术相比，OPCAB手术的临床结果有所改善，但术后胸部X线片分析仅显示出轻微益处，如OPCAB组左肺不张程度降低所示。
