2026 年第 7 期 第 21 卷

多学科协作抗凝管理在冠状动脉旁路移植术同期行冠状动脉内膜剥脱术后的应用

Application of multidisciplinary collaborative anticoagulation management after simultaneous coronary endarterectomy during coronary artery bypass grafting

作者：欧水珍程云清甄健帆孙图成杨圆圆

英文作者：Ou Shuizhen Cheng Yunqing Zhen Jianfan Sun Tucheng Yang Yuanyuan

单位：广东省人民医院心外科，广州510000 甄健帆现工作单位为广东省中山市人民医院心胸外科

英文单位：Department of Cardiac Surgery Guangdong Provincial People′s Hospital Guangzhou 510000 China Zhen Jianfan currently works in the Department of Cardiothoracis Surgery Zhongshan People′s Hospital Guangdong Province

关键词：冠状动脉内膜剥脱术；冠状动脉旁路移植术；多学科团队协作；抗凝管理

英文关键词：Coronaryendarterectomy;Coronaryarterybypassgrafting;Multidisciplinaryteamcollaboration;Anticoagulationmanagement

• 摘要：

• 目的 总结冠状动脉旁路移植术（CABG）同期行冠状动脉内膜剥脱术（CE）的多学科协作抗凝管理经验，为临床医护提供参考。方法 回顾性纳入2017年9月至2024年6月广东省人民医院接受CABG联合CE治疗的90例患者，按术后抗凝方案分为多学科协作抗凝组（45例）与常规抗凝组（45例），比较2组术后总出血事件发生率及早期移植血管通畅率。结果 90例手术患者中7例术后需要主动脉内球囊反搏辅助。重症监护室监护时长为97.0（59.7,163.0）h，机械通气时间为20.0（17.0,48.2）h。3例在围手术期发生心肌梗死，1例发生消化道出血事件，5例发生其他出血事件、5例发生脑血管意外。平均住院天数（27±11）d。术后3例患者及家属选择自动出院。1例患者在随访期间死亡。1例患者在术后第2个月存在1条非剥脱部位的靶血管再次行冠状动脉支架置入治疗。术前和术后纽约心脏病协会心功能分级3～4级所占的比例分别为67.8%（61/90）和16.7%（15/90）。多学科协作抗凝组术后24 h引流量、总出血事件发生率及术后输血率均低于常规抗凝组［（347±52）ml比（451±61）ml、0（0/45）比13.3%（6/45）、4.4%（2/45）比17.8%（8/45）］，早期移植血管通畅率高于常规抗凝组［95.6%(43/45）比82.2%(37/45)］，差异均有统计学意义（均P＜0.05）。多学科协作抗凝组与常规抗凝组移植血管闭塞率及狭窄≥50%发生率比较，差异均无统计学意义（均P＞0.05）。结论 CABG联合CE术后采用多学科协作抗凝管理可显著减少出血风险并提高移植血管早期通畅率。

• Objective To summarize the experience of multidisciplinary collaborative anticoagulation management for patients undergoing simultaneous coronary endarterectomy (CE) during coronary artery bypass grafting (CABG), so as to provide reference for clinical medical staff. Methods A total of 90 patients receiving combined CABG and CE in Guangdong Provincial People′s Hospital from September 2017 to June 2024 were retrospectively enrolled. The patients were divided into multidisciplinary collaborative anticoagulation group (45 cases) and routine anticoagulation group (45 cases) according to postoperative anticoagulation regimens. Postoperative total incidence of bleeding events and early graft patency rate were compared between the two groups. Results Among the 90 surgical patients, 7 cases required postoperative intra-aortic balloon pump support. The intensive care unit stay was 97.0(59.7, 163.0)h, and the mechanical ventilation duration was 20.0(17.0, 48.2)h. Perioperative myocardial infarction occurred in 3 patients, gastrointestinal bleeding in 1 patient, other bleeding events in 5 patients, and cerebrovascular accidents in 5 patients. The average hospital stay was (27±11) d. Three patients and their families chose self-discharge after surgery, 1 patient died during follow-up, and 1 patient received secondary coronary stent implantation for restenosis of a target vessel at non-endarterectomy site at the second month after operation. The proportions of patients with New York Heart Association cardiac function class 3-4 before and after surgery were 67.8%(61/90) and 16.7%(15/90), respectively. The 24 h postoperative drainage volume, total incidence of bleeding events and postoperative blood transfusion rate in the multidisciplinary collaborative anticoagulation group were lower than those in the routine anticoagulation group ［(347±52)ml vs (451±61)ml, 0(0/45) vs 13.3%(6/45), 4.4%(2/45) vs 17.8%(8/45)］, while the early graft patency rate was higher ［95.6%(43/45) vs 82.2%(37/45)］(all P＜0.05). There were no statistically significant differences in the incidence of graft occlusion and graft stenosis ≥50% between the two groups (both P＞0.05). Conclusion Multidisciplinary collaborative anticoagulation management after combined CABG and CE can significantly reduce bleeding risk and improve early graft patency rate.