急诊冠状动脉旁路移植术的临床应用

Effectiveness of emergency coronary artery bypass grafting

目的 总结采用急诊冠状动脉旁路移植术 (ECABG)治疗 6h内急性心肌梗死 (AMI)、经皮冠状动脉腔内成形术 (PTCA)失败和左冠状动脉主干 (LM )严重狭窄患者的临床经验。方法 2 0 0 1年 1月～ 2 0 0 3年 2月分别对 9例 6h内AMI、2例PTCA失败和 9例LM严重狭窄的患者行ECABG手术。结果 平均移植血管桥(2 .6± 0 .7)支 ,心脏自动复跳 17例 ,使用主动脉内气囊反搏装置 (IABP) 7例 ;体外循环时间为 (10 9± 2 3)min ,升主动脉阻断时间为 (78± 17)min ,术后呼吸机辅助时间为 (2 0± 13)h ;住院期间死亡 2例 ;肾功能衰竭行急诊血液透析 2例 ,院内感染 9例 ,心低排血量 8例 ,难治性心律失常 6例 ,脑血管意外 1例 ,胸骨感染 1例 ,下肢感染 1例。全组患者无围术期心肌梗死 ,无再次手术止血。平均随访 (16 .4± 4 .3)个月 ,仅 1例于术后 2个月出现反复右心功能衰竭症状 ,其余患者心绞痛症状完全消失。复查超声心动图示左心室收缩功能明显改善。结论 只要适应证选择得当 ,对 6h内AMI、LM严重狭窄和PTCA失败的患者行ECABG是安全、有效的。

Objective To summarize the clinical experience of emergency coronary artery bypass grafting(CABG) for acute myocardial infarction (AMI) within 6 hours of onset in case of failed percutaneous transluminal coronary angioplasty (PTCA) and severe left main (LM) trunk stenosis.Methods Twenty cases of emergency CABG were performed, 9 for AMI, 2 for failed CABG, and 9 for severe LM stenosis.Results The average graft transplantation was 2.6±0.7, CPB time was (109±23) min, and aortic occlusion time was (78±17) min. Mean intubation time was (20±13) h. The main postoperative complications were renal failure in 2, inhospital infection in 9, low cardiac output syndrome in 8, refractory arrhythmia in 6; stroke, sternum infection, lower limb wound infection in one for each. No perioperative MI and no re-entry for active bleeding were found. Inhospital mortality was 10% (two cases). The mean follow-up period was (16.4±4.3)months. Angina disappeared in all patients postoperatively except one case with refractory right heart failure during follow-up. Echocardiography follow-up study revealed improved left ventricular function.Conclusion Emergency CABG is a life saving therapy for acute myocardial infarction within 6 hours of onset for failed percutaneous transluminal coronary angioplasty and severe left main trunk stenosis.