急诊冠状动脉搭桥术的围手术期处理

The perioperative treatment of emergency coronary artery bypass

目的探讨急诊冠状动脉搭桥术(E-CABG)的围手术期处理措施的特点。方法回顾分析67例E-CABG患者的术前病情、术前准备、围手术期的处理措施及术后随访,总结急诊搭桥围手术期的处理特点。结果59例抢救成功,手术成功率为88.1%。术后IABP放置时间平均(40.0±8.0)h,机械通气平均(16.3±7.5)h,术后平均心排量(CO(4.6±1.4)L/min、肺动脉楔压(PCWP(15.3±5.2)mmHg、中心静脉压(CVP(14.5±4.3)cmH2O、术后24)))h心包纵隔引流(1000±430)ml,无围术期心肌梗死及其他严重并发症,存活者均随访10～35个月,无心绞痛及心肌缺血表现。结论E-CABG使急性冠脉综合征患者受益。不同类型的冠心病急症采用不同的手术方式,可获得较高的成功率。

Objective To investigate the peri-operative treatment of emergency coronary artery bypass （E-CABG）. Methods Data of 67 patients underwent E-CABG were reviewed for the pre-operative characters, pre-operative preparation, peri-operative treatment and post-operative results. Summarize the characteristic of peri- operative treatment for E-CABG. Results 59 cases survived, operative mortality in this group was 11.9%. The mean time on IABP was （40.0±8.0）hours. The average time of mechanical ventilation was （16.3±7.5）hours. The mean postoperative cardiac output, PCWP, CVP was 4.6±1.4L/min, （15.3±5.2）mm Hg and （14.5±4.3）cm H2O respectively. The blood loss via chest tubes was （1000±430）ml in first 24 h. No peri-operative myocardial infarction and others complications occurred. No recurrent angina or cardiac ischemia during the time of follow-up （10 to 35 months）. Conclusions Patients with acute coronary syndrome benefited from E-CABG with an acceptable operative mortality.