冠状动脉搭桥术后二次开胸止血的临床分析(附1608例报告)

Clinical analysis of reoperations for bleeding after coronary artery bypass

目的探讨冠状动脉(简称冠脉)搭桥术后二次开胸止血的相关危险因素及出血的常见部位。方法选择我院1994年1月至2004年10月完成冠脉搭桥术(CABG)者1608例(包括97例搭桥+其他心脏手术),其中术后二次开胸止血45例,总结临床资料,并对可能的相关危险因素、常见出血部位进行单因素分析。结果乳内动脉的使用、急诊冠脉搭桥术、术前停用抗血小板药物<7d者、合并有高血压、CABG+其他手术、年龄>70岁者术后二次开胸止血的发生率高,有显著性差异(P<0.05),与是否体外循环、合并糖尿病、搭桥的支数无相关性。28例有明确出血,部位依次是:乳内动脉及其床面、静脉桥、胸骨、升主动脉插管口、膈肌切口、胸腺窝、钢丝孔。结论术前充分准备、尽可能避免相关危险因素可减少术后出血。

Objective To investigate the common sites and risk factors of reoperation for bleeding after CABG. Methods 1608 CABG procedures （including 97 combined with other procedures） in our hospital during 1994-2004 were revleaed, there were 45 patients needed reoperation for bleeding. Factors that might affect the result of reoperation were analyzed by single-factor analysis. Results The following factors were related to high rates of reoperation （P〈0.05）： the IMA used, E-CABG, antithrombotic medication discontinued less 7days before elective surgery, concurrent hypertension, combined with other surgery, procedures and ages 〉70 years. It was not significantly related to CABG or OPCAB, concurrent diabetes, number of grafts inserted. Major sources of bleeding found in 28 patients were the IMA and its vesswls bed, vein grafts, sternum, aortic faucet, midriff, thymus gland bed vessels. Conclusions Prepared satisfactorily before operation and avoid risk factors can reduce reoperation for bleeding.