280例冠状动脉旁路移植术临床分析

Clinical Analysis of Coronary Artery Bypass Graft, A Report of 280 Cases

目的 总结分析非体外循环冠状动脉旁路移植术（OPCAB）治疗冠心病的效果和临床经验。方法 1998年3月-2004年10月，280例冠心病（CAD）患者接受冠状动脉旁路移植术（CABG）。OPCAB实施率（即OPCAB占单纯冠状动脉旁路移植术的百分比）为94．7％。平均年龄63．1岁。合并瓣膜病变11例，合并室壁瘤9例。左室射血分数（LVEF）平均（47±14）％。5例急诊手术，其中2例术前放置主动脉内球囊反搏（IABP）。32例在常规体外循环下手术；248例采用非体外循环心脏不停跳技术，术中改施体外循环6例，其中5例全动脉化、2例全静脉化旁路移植术。结果 平均每例远端吻合口2．95。4例左前胸部小切口单支病变旁路移植术，其余均为正中切口，多支病变的CABG手术。死亡3例（1.07％）。结论 OPCAB手术安全可行，早期效果满意，远期效果有待进一步观察。实施OPCAB要求具备独特的技术和方法。

Objective To investigate curative effect of off pump coronary artery bypass（OPCAB） tor coronary heart disease and summarize the clinical experience. Methods The clinical data of two hundred and eighty cases with coronary artery disease underwent coronary artery bypass graft （CABG） was analyzed retrospectively. The ratio of OPCAB to conventional coronary artery bypass grafting （CCABG） was 94.7%. The average age of patients was 63.1 years. 11 cases combined with valve replacement or valve plasty. 9 cases with left ventricular aneurysm. The average left ventricular ejcction fraction （LVEF） was （47 ± 14） %. Emergency surgical revascularization was perfomed in 5 patients in whom 2 cases were treated with intra aortic balloon pump （IABP） before surgery, 32 cases underwent coronary artery revascularization with conventional cardiopulmonary bypass （CPB）. 248 with OPCAB （6 patients were converted to CPB in operation）. 5 cases received total arterial revascularization and 2 received total venous conduits, Results The average number of distal anastomoses was 2.95/pt, 4 cases were with mono branch received left front thoracic wall small incision CABG, Others with multi branches received median incision CABG. The mortality is 1.07% （3/280）. Conclusions OPCAB surgery is a safe and feasible procedure with satisfactory early results. its late outcomes need further more follow-up observation. OPCAB requires special skills and methods in practice.