重症冠心病非体外循环冠状动脉旁路移植术及围术期处理

Off-pump coronary artery bypass grafting and preoperative treatment for 20 patients with severe coronary artery diseases

目的 总结重症冠心病在非体外循环心脏不停跳下行冠状动脉旁路移植术 ( OPCABG)的经验。方法 2 0例重症冠心病者 ,全部采用 OPCABG,选用乳内动脉、桡动脉、大隐静脉作为移植血管材料。共搭桥 64支 ,平均 3 .2支。术中使用 CTS心脏固定器。加强围手术期处理。结果 全组无围术期急性心肌梗塞 ,无死亡病例。术后心绞痛症状全部缓解 ,住院天数为 1 9～ 45天 ,平均 2 5 .2天。结论 非体外循环冠状动脉搭桥手术安全、有效 ,可用于多支病变或 /和危重急症患者。主动脉内球囊反搏是治疗冠心病严重并发症和围手术期心衰很有效的辅助装置。合理的围术期处理对手术效果很重要。

Objective To sum up the clinic experience of off pump coronary artery bypass grafting for patients with far advanced coronary lesion and another organs diseases.Methods Off pump coronary artery bypass grafting underwent beating heart were applied to 20 patients with severe coronary artery disease, including 15 of LVEF 0 4～0 49, 4 of LVEF 0 3～0 39, 1case of LVEF <0 3. Percutaneous transluminal coronary angioplasty(PTCA)and implantation of introcoronary stent have been placed in 6 patients. Inter aortic balloon pump (IABP) was used in 3 cases underwent acute myocardium infarction and cardiogenic shock preoperation. The grafts include mammary artery, radial artery, saphenous vein. The average number of graft is 3.2 piece in per case. Stabilizers of CTS were used during operation.Results No off pump was changed to on pump and myocardium infarction condition happened post operation and mortality in this group. All cases recovered smoothly. Patients stayed in hospital from 19～45 days, to average 25 2 days.Conclusions Off pump coronary artery bypass grafting is safe, effective, benefit, economy for multivascular diseases and severe cases. It is important of adequately preoperative medical remedy, IABP,allround postoperative treatment.