老年冠状动脉搭桥手术体外循环总结

The Management of on Pump Coronary Artery bypass Grafting in Senile Patients

目的 对 2 0例冠状动脉搭桥手术 (CABG)患者的体外循环 (CPB)方法、心肌保护、血液保护措施 ,进行回顾性总结。方法 2 0例中 ,17例老年冠心病患者行CABG术 ,2例患者行急诊冠状动脉搭桥手术 (ECABG) ,1例行主动脉瓣置换 (AVR)加 (CABG)术 ;其中 3例应用主动脉球囊反搏泵 (IABP)支持。全组男 18例、女 2例 ,年龄 6 5～78岁 ,体重 5 4～ 85kg ,术前均合并中、重度高血压 ;合并糖尿病者 14例 ;全部采用中度低温CPB ,自制高钾冷、温血停搏液顺灌、逆灌、桥灌 ,取得较好心肌保护效果。结果 全部康复出院 ,无死亡。结论 提高手术技术 ,减少主动脉阻断时间 ,停机困难者尽早应用 (IABP) ;采取综合的心肌保护措施及血液保护对手术成功有重要作用。

OBJECTIVE To retrospect the technology of cardiopulmonary bypass in coronary artery bypass graft (CABG) procedures in senile patients. METHODS 20 senile patients underwent open heart surgery from May 2002 to December. 2002; CABG was performed on 17 patients,emergency CABG in 2,in 1 case for CABG combined with aortic valve replacement (AVR). Intraaortic ballon pump (IABP) was required in 3 cases. The myocardial protection was used 4:1 blood cardioplegia antegrade or retrograde perfusion. RESULTS There was no operative mortality. All patients recovered and were discharged. CONCLUSION Improving surgical technique,reducing aortic cross clamp time,early application of IABP when weaning from pump is difficult and myocardial protection and blood protection are important for success.