冠状动脉旁路移植术治疗冠心病64例体会

Experience of coronary artery bypass graft on 64 cases

目的 总结 64例冠心病患者实施冠状动脉旁路移植术 (CABG)的经验。方法 胸部正中、左前臂和 /或小腿内侧切口 ,分别取左乳内动脉、左桡动脉及和 /或大隐静脉作为移植血管。体外循环 (PCAB)组 3 6例 :采用全麻、中低温体外循环 ,1∶4含血停跳液 (10℃～ 15℃ )行心肌保护。平均每例搭桥 3 .6根。非体外循环 (OPCAB)组 2 8例 :应用Medtronic公司生产的固定器 (八爪鱼 )行吻合口局部固定。平均每例搭桥 3 .4根。结果 两组患者在年龄、性别、临床症状、术前合并症、左室射血分数 (EF)、心胸比例、冠状动脉造影病变程度及移植血管支数等相对比均无显著性差异(P >0 .0 5 ) ,但手术时间、术后ICU时间、术后血管活性药物应用时间及并发症等均有明显的差别(P <0 .0 5 )。术后心电图均显示心肌缺血明显改善 ,左心室射血分数明显提高。结论 OPCAB下行CABG可避免PCAB对机体及心肌的再灌注损伤 ,明显降低术后并发症。熟练掌握乳内动脉和桡动脉取材方法 ,预防血管痉挛 ,提高吻合技术 ,是手术成功的关键。

Objective To review the experience of coronary artery bypass graft (CABG) surgery on 64 patients suffering from coronary artery disease (CAD).Method CABG surgery was performed on 64 patients.The left internal thoracic artery,the left radial artery, and (or) the great saphenous vein were taken up as bypass grafts. Thirty six patients received surgery on arresting hearts with moderate hypothermic cardiopulmonary bypass (CPB).The other 28 patients received surgery off CPB with the cardiac arrester (Octopus) on beating hearts (OPCAB).Results There was no significant difference between the two groups before the operations(P>0.05).But different results came out in the time of operation, the time of ICU,the time of the use of vasoactive drugs and the incidence of the post operative complications(P<0.05).Not only the syndrome from myocardia ischemia disappeared but the left ventricular ejection fraction (LVEF) increased.Conclusion The OPCAB may prevent the heart as well as the body from injuring by CPB and lower the incidence of the post operative complications.A skilled management of the bypass grafts and a skilled anastomosis are the keys to the success of CABG surgery. [