BACKGROUND:Adverse effects on the respiratory system can be severe in many instances after coronarv artery bypass grafting (CABG) with cardiopulmonary bypass (CPBP). Recently, operative techniques without CPBP have gained widespread consent, thanks to the newly developed retractors that allow satisfactory immobilisation of the surgical field. METHODS:Thirty-seven patients operated upon in our Institution between April 1997 and April 1998 showed an obstructive and/or restrictive pulmonary disease. Twenty-one patients were operated on without CBPB (group A), while 16 patients were operated using CPBP (group B, control). The allocation in each group had been randomised. RESULTS:The length of the operation in group A was less than in group B (196+/-35 minutes vs 235+/-60 minutes), (p=0.014). A significant difference was found in postoperative bleeding: 562+/-381 ml vs 776+/-378 (p=0.046), in postoperative red cell count, hemoglobin level and Hct. Permanence on the ventilator was 19.1+/-13 hours in group B and 13.1+/-6.1 hours in group A (p=0.03). The length of stay in ICU was significantly different: 33.8+/-16.2 hours for group A vs 53.6+/-29.3 hours for group B (p=0.01). No respiratory failure occurred in group A; two patients experienced slow weaning from ventilation assistance and one died from that complication in group B. CONCLUSIONS:Myocardial revascularization without CPBP allows a better postoperative clinical course in patients with advanced pulmonary disease.

译文

背景:冠状动脉搭桥术(CABG)和体外循环(CPBP)在许多情况下,对呼吸系统的不良影响可能很严重。近来,由于新开发的牵开器能够令人满意地固定手术区域,因此没有CPBP的手术技术已获得广泛认可。
方法:1997年4月至1998年4月在我们机构接受手术的37例患者出现阻塞性和/或限制性肺部疾病。 21例无CBPB的患者接受了手术(A组),而16例采用CPBP的患者接受了手术(B组,对照组)。各组的分配已随机化。
结果:A组的手术时间少于B组(196 / -35分钟vs 235 / -60分钟),(p = 0.014)。在术后出血中发现了显着差异:562 / -381 ml对776 / -378(p = 0.046),术后红细胞计数,血红蛋白水平和Hct。 B组呼吸机的持久性为19.1 / -13小时,A组呼吸机的持久性为13.1 /-6.1小时(p = 0.03)。在ICU的住院时间明显不同:A组为33.8 /-16.2小时,B组为53.6 /-29.3小时(p = 0.01)。 A组未发生呼吸衰竭; B组中有2例患者在通气辅助下断奶缓慢,其中1例因并发症而死亡。
结论:没有CPBP的心肌血运重建术可以使晚期肺部疾病患者获得更好的术后临床过程。

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