杂交技术在冠状动脉外科中的应用

Hybrid techniques in coronary revascularization

目的 总结29例杂交技术治疗冠心病的临床疗效. 方法 2000年1月～2005年4月,29例冠心病接受杂交技术进行心肌血管化.均为男性,年龄（62.8±9.7）岁.其中合并高血压23例,糖尿病5例,慢性阻塞性肺病2例,陈旧性心肌梗死14例.二支病变10例,三支病变19例.左室射血分数0.576±0.108. 结果 29例接受33根移植物,其中左乳内动脉（left internal mammary artery,LIMA）27支,大隐静脉6支.共植入支架41个.平均每例心肌血管化2.5支.全组无死亡,无住院并发症.LIMA血流量（45±14） ml/min.胸腔引流量（274±197） ml,2例（6.9%）接受输血.ICU时间（1.9±0.1） d.术后住院4～11 d,平均7.5 d.29例随访0.5～5.1年,（2.2±0.9）年,无远期死亡和心肌梗死.术后心功能NYHA分级Ⅰ级25例,Ⅱ级4例.冠脉造影共4例,大隐静脉桥血管闭塞1例,支架内再狭窄2例. 结论 杂交技术治疗冠心病中期疗效满意,适用于高危病人,其长期效果有待进一步评价.

Objective To summarize clinical results of 29 cases of multi-vessel coronary disease treated by hybrid revascularization. Methods A total of 29 consecutive patients （ all male, aged 62.8 ± 9.7 years） with coronary artery disease （ two- vessel, n = 10 ; three-vessel, n = 19） were treated with minimally invaslve direct coronary artery bypass （MIDCAB） （ left internal mammary artery to left anterior descending artery, LIMA-to-LAD） and percutaneous coronary intervention （PCI） between January 2000 and April 2005. The left ventricular ejection fraction （LVEF） was 0. 576 ± 0. 108. Concomitant diseases included hypertension in 23 patients, insulin-dependent diabetes mellitus in 5 patients, chronic obstructive pulmonary disease in 2 patients, and old myocardial infarction in 14 patients. Results The 29 patients received 33 grafts （LIMA： 27 grafts; great saphenous vein： 6 grafts）. Balloon angioplasty was carried out in 41 coronary lesions, usually following surgery. The mean number of revascularization was 2.5 per patient. There was no surgery-related complications and mortality. The blood flow in the LIMA was 45 ± 14 ml/min. The chest drainage volume was 274 ±197 ml. Blood transfusion was required in 2 patients （6.9%）. The length of ICU stay was 1.9 ± 0. 1 d and the length of hospital stay was 4 - 11 d（ mean,7.5 d）. Follow-up for 2.2 ± 0.9 years showed no late death and myocardial infarction. Postoperative New York Heart Association （NYHA） Classification showed Class Ⅰ in 25 patients and Class Ⅱ in 4 patients. Repeated angiography was conducted in 4 patients, which found great saphenous vein graft occluded in 1 patient and stent re-stenosis in 2 patients. Conclusions The midterm results of hybrid techniques for coronary artery disease are satisfactory. Hybrid procedure is beneficial to high-risk patients. The long-term results need further investigation.