| Abstract | CILJ: Cilj istraživanja je usporediti perioperacijsku i ranu poslijeoperacijsku smrtnost i pobol bolesnika obzirom na dvije tehnike revaskularizacije miokarda. Dobivenim rezultatima se želi utvrditi postoji li razlika između dviju tehnika revaskularizacije miokarda obzirom pobol i smrtnost u ranom perioperacijskom i poslijeoperacijskom razdoblju.
BOLESNICI I METODE: U prospektivnom randomiziranom istraživanju obradili smo 100 bolesnika s izoliranom IBS liječenih na Zavodu za kardijalnu kirurgiju, Klinike za kirurgiju, Kliničkog bolničkog centra Rijeka. Metodom slučajnog odabira bolesnici su bili podijeljeni u dvije grupe. Grupu I sačinjavalo je 50 bolesnika kojima je kirurška revaskularizacija miokarda učinjena uporabom izvantjelesnog krvotoka uz fibrilaciju klijetki i povremenu okluziju aorte (KRM-ITK-FK), grupu II činilo je 50 bolesnika kojima je kirurška revaskularizacija miokarda učinjena bez uporabe izvantjelesnog krvotoka (KRM-BITK). Sve bolesnike operirao je isti operater. Baza podataka bila je učinjena u "Exel 5.0/7.0" Microsoftovom programu, a zatim konvertirana u statistički paket "Statistica 8,0", StatSoft, Inc., Tulsa, OK, SAD, u kojem je učinjena statistička obrada.
REZULTATI: U osnovnim demografskim značajkama, udruženim bolestima i navikama nije bilo statistički značajne razlike među skupinama. Dužina operacije bila je značajno duža u skupini KRM-ITK-FK i iznosila je 203±52 u odnosu na 173±60 (p<0,011). Značajna razlika nađena je i u visini vrijednosti biljega oštečenja srčanog mišića koji su bili znatno viši u skupini KRM-ITK-FK i iznosila je za CK MB 16,5±18,0 nasuprot 7,9±12,3 (p<0,007), troponin 5,81±7,66 nasuprot 2,05±2,87 (p<0,002), kao i u visini intraabdominalnog tlaka (IAT) 9,7±3,4 nasuprot 7,1±2,8 (p<0,001). U skupini KRM-ITK-FK značajno je češće provođena poslijeoperacijska hemodijaliza (p<0,009). Nije nađena veća incidencija poslijeoperacijskog infarkta (PIM) između pojedinih skupina uz ukupnu incidenciju od 3%. U incidenciji smrtnosti nije bilo značajne razlike među ispitivanim skupinama uz ukupnu incidenciju od 3%.
ZAKLJUČAK: Smatramo da se radi o dvije usporedive tehnike kirurške revaskularizacije miokarda obzirom na unutarbolničku smrtnost, ali uz povećani riziko pogoršanja bubrežne funkcije osobito u bolesnika sa već postejećim oštećenjem bubrega u skupini KRM-ITK-FK.
U bolesnika sa postojećom oštećenom bubrežnom funkcijom predlažemo koristiti tehniku kirurške revaskularizacije bez uporabe ITK. |
| Abstract (english) | OBJECTIVES: The aim of the research was to compare the perioperative and early postoperative mortality and morbidity of patients given the two techniques of myocardial revascularization - intermittent aortic cross clamping versus off pump coronary artery bypass. Through the obtained results we wanted to determine if there was a difference between the two techniques of myocardial revascularization during the perioperative and early postoperative period.
PATIENTS AND METHODS: In a prospective randomized study we have treated 100 patients with isolated coronary artery diesese at the Department of Cardiac Surgery, Department of Surgery, University Hospital Centre Rijeka. Patients were randomly divided into two groups: Group I consisted of 50 patients who underwent surgical revascularization using extracorporeal circulation to ventricular fibrillation and intermittent aortic cross clamping (CABG), • Group II consisted of 50 patients who underwent surgical revascularization without extracorporeal circulation (OPCABG). All patients were operated by the same surgeon. The database was done in the "Exel 5.0/7.0" Microsoft programs, and then converted into the statistical package Statistica 8.0, StatSoft, Inc., Tulsa, OK, USA. in which statistical analysis was performed.
RESULTS: There were no statistically singificant differences between the groups related to the basic demographic characteristics, comorbidity, and habits. Length of surgery was significantly longer in CABG group and was 203 ± 52 compared to 173 ± 60 (p <0.011). Significant differences were also found in the amount of the value of markers of heart muscle damage, which were significantly higher in the CABG group and were the CK MB 16.5 ± 7.9 versus 18.0 ± 12.3 (p <0.007), Troponin 5.81 ± 7.66 versus 2.05 ± 2.87 (p <0.002), as well as in the amount of intraabdominal pressure (IAT) 9.7 ± 3.4 versus 7.1 ± 2.8 (p <0.001). In the CABG group postoperative hemodialysis was significantly more frequently carried out (p <0.009). Postoperative myocardial infarction (PIM) was found in both groups with the overall incidence of 3%. The incidence of mortality was no significately diferent between the two groups, with the overall incidence of 3%.
CONCLUSION: Given the above, we believe that CABG and OPCABG are two comparable techniques of surgical myocardial revascularization regarding intrahospital mortality, but with an increased risk of worsening renal function, especially in patients with the history of renal impairment, when treated with CABG technique.
In the patients with existing renal failure and chronic obstructive pulmonary disease we suggest the technique of surgical myocardial revascularization without the use extracorporeal circulation.
In patients without preoperative renal impaired function and without chronic obstructive pulmonary disease any of the above techniques of surgical revascularization of the heart may be used by the discretion of the surgeon. |
