Bilateral skeletonized internal thoracic artery grafts in patients with diabetes mellitus
Bilateral skeletonized internal thoracic artery grafts in patients with diabetes mellitus
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DOI：
10.1067/mtc.2001.112824
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发表时间：
2001-04-01
影响因子：
6
通讯作者：
Mohr, R
中科院分区：
文献类型：
--
作者：
Matsa, M;Paz, Y;Mohr, R
目的：胸骨深部感染风险的增加阻碍了糖尿病患者常规的双侧胸腔内动脉移植，截取骨化胸腔内动脉的技术提供了将这种风险降至最低的可能性。方法：自1996年5月至1998年4月，对231例糖尿病患者和534例非糖尿病患者行双侧胸廓骨化动脉搭桥术。平均年龄66岁。与非糖尿病组相比，糖尿病组女性更多(29%比18%，P=.001)，高血压(53%比44%，P=.019)和充血性心力衰竭(20%比14%，P=0.016)，但术前急性心肌梗死(26%比34%，P=0.027)。结果：糖尿病患者的手术死亡率与非糖尿病患者(3%比2.6%)相当。两组胸骨深部感染的发生率也相似(分别为2.6%和1.7%，P=.40)，肥胖和糖尿病妇女胸骨深部感染的发生率(3/20=15%)明显高于没有合并危险因素的糖尿病患者(3/211=1.4%，P<；0.0001)(优势比11.1，可信区间2.1-59.4)。糖尿病患者的中风发生率也较高(3.5%对0.9%，P=.014)。糖尿病患者的3年精算生存率较低(91.3%vs94.7%，P=.083)。结论：双侧胸廓骨化内动脉移植是糖尿病患者良好的手术血运重建选择。手术死亡率和胸骨感染发生率与非糖尿病患者相当。然而，肥胖的糖尿病女性胸骨感染的风险很高，对于她们，我们主张使用单一动脉而不是双侧胸内动脉。
Objective: Increased risk of deep sternal infections has prohibited routine bilateral internal thoracic artery grafting in diabetic patients, The technique for harvesting the skeletonized internal thoracic artery provides the potential to minimize this risk. The purpose of this study was to compare the outcome of bypass grafting with bilateral skeletonized internal thoracic arteries in diabetic and nondiabetic patients.Methods: From May 1996 to April 1998, 231 consecutive diabetic and 534 nondiabetic patients underwent bilateral skeletonized internal thoracic artery grafting. Mean age was 66 years. Compared with the nondiabetic group, the diabetic group comprised more women (29% vs 18%, P = .001), had a greater prevalence of hypertension (53% vs 44%, P = .019) and congestive heart failure (20% vs 14%, P = .016), but a lower prevalence of preoperative acute myocardial infarction (26% vs 34%, P = .027).Results: Operative mortality of diabetic patients was comparable with that of nondiabetic patients (3% vs 2.6%). The two groups also had similar occurrences of deep sternal infection (2.6% vs 1.7%, respectively, P = .40), Deep sternal infection was significantly more prevalent in obese, diabetic women (3/20 = 15%) than in diabetic patients without this combination of risk factors (3/211 = 1.4%, P < .0001) (odds ratio 11.1, confidence interval 2.1-59.4). Diabetic patients also had a higher incidence of stroke (3.5% vs 0.9%, P = .014). Three-year actuarial survival of diabetic patients was lower (91.3% vs 94.7%, P = .083).Conclusions: Bilateral skeletonized internal thoracic artery grafting is a good surgical revascularization option in diabetic patients. Operative mortality and prevalence of sternal infection are comparable with those of nondiabetic patients. However, the risk of sternal infection in obese diabetic women is high, and for them we advocate the use of a single artery instead of bilateral internal thoracic arteries.