非体外循环下冠状动脉搭桥术的临床体会

Clinical experience of off-pump coronary artery bypass procedure.

目的总结非体外循环下冠状动脉搭桥术的经验。方法1999年8月2日～2001年12月31日,共行非体外循环冠状动脉搭桥术80例,男65例,女15例,年龄为43～73岁,平均为65.1岁。其中稳定型心绞痛23例,不稳定型心绞痛57例,血管病变程度均大于70%。IVD(I支血管病变)3例(3.8%),IIVD(II支血管病变)11例(13.8%),IIIVD(III支血管病变)66例(82.5%),合并左主干病变27例(33.8%),血管狭窄程度为50%～90%。心脏射血分数为40.3%～62.6%,平均为47.3%,合并有糖尿病31例(38.6%)、高血压27例(33.8)、多发性脑梗塞2例、肾功能中度损害2例(2.5%)、颈内动脉狭窄大于60%8例(10%)、术前有陈旧性心肌梗死36例(45%)。术中发现主动脉钙化斑块2例(2.5%),术中改成体外循环手术2例(2.5%)。结果用LIMA-左前降支76例,左桡动脉桥5例,其余联合应用大隐静脉搭桥,应用单支桥或序贯式搭桥或Y型桥的方法I支血管病变搭桥4根,II支血管病变搭桥25根,III支血管病变搭桥205根,全组人均搭桥2.9根(1～5根)。围术期心梗1例,死亡1例,脑卒中发生1例。出院时患者均无心绞痛主诉。结论OPCABG避免了CPB的并发症及缺血再灌注损伤,特别是对体外循环高危病人更有益。病人恢复快,住院时间短。但因手术难度较大,需对病人有一定选择,远期疗效有待进一步观察。

Objective To summarize the clinical experience in 80 cases undergo off-pump coronary artery bypass(OPCABG). Methods 80 cases off-pump coronary artery bypass performed in our center from Aug 1999 to Dec 2001.The mean age was 65.1 years.65patients were male.15patients were female.There were 71.3%with unstable angina pectoris,33.8% with left main lesion.IVD were 3 cases(3.8%).IIVD were 11 cases(13.8%).IIIVD were 66 cases(82.5%).The mean left ventricular ejection was 47.3%. Result The mean number of distal anastomosis was 2.9(1～5).LIMA was used in 95% patients and radial artery was used in 6.3%.The rest were combined with Svg.The hospital mortality and myocardial infarction all was 1.25%. Conclusion OPCABG surgery is a safe and feasible procedure which can avoid the complication with CPBCABG..Its late outcomes need further follow-up.