危重病人冠状动脉旁路移植术的效果(附80例报告)

CORONARY ARTERY BYPASS GRAFTING ON HIGH RISK CORONARY HEART DISEASES

目的 探讨危重冠心病病人行冠状动脉旁路移植术（CABG）的效果。方法 回顾分析2001年5月～2005年4月80例高危冠心病病人行CABG的临床资料。80例病人平均年龄（66．24±8．5）岁。术前1月内急性心肌梗死14例，3例室壁瘤形成，1例为急性心肌梗死并室间隔穿孔、心源性休克。80例病人均伴有多项高危因素。体外循环下行CABG62例；非体外循环下CABG（OPCABG）18例，其中7例为急诊手术。平均移植血管（3．2±1．1）支。结果 围术期死亡4例，占5％。其中2例为急诊手术病人，1例OPCABG术后3h突发心室颤动；1例急性心肌梗死并室壁瘤、室间隔穿孔病人，术后3d死于顽固低心排。1例术后5d死于急性肾衰竭。纵隔感染伴真菌性败血症致死亡1例。其他术后主要并发症包括：低心排17例，明显影响血流动力学参数的心律失常12例，肺部并发症16例，术后脑梗死1例，切口感染3例。随访时间3～50个月，98％的病人心绞痛消失，心功能Ⅰ～Ⅱ级。结论 CABG治疗危重冠心病病人有相对较高的病死率和并发症发生率，应强调手术指征和手术时机的把握，加强围手术期的管理。

Objective To describe our experience on coronary artery bypass grafting （CABG） in 80 patients with high risk coronary disease. Methods From May 2001 to June 2005, 80 patients with high risk factors received CABG. Sixty-two patients were operated under cardiopulmonary bypass and 18 with off-pump CABG （OPCABG）. Cardioplegic arrest was obtained with combined antegrade and retrograde cardioplegia using hyperkalemic cold blood solution. Results Four patients died in hospital, each of them died of one of the following reasons： ventricular arrhythmia, low cardiac output, renal failure or mediastinal infection complicating fungal septicemia. The other post-operative complications were arrhythmia （12 cases）, low cardiac output syndrome （17 cases）, lung complications （16 cases）, cerebral infarction （1 cases）, and wound infection （3 cases）. A follow-up of 3-50 months showed that 98% of the patients were angina-free with the heart function being Ⅰ - Ⅱ class （NYHA）. Conclusion Correspondingly high mortality and mobidity are noted in patients with high risk coronary heart disease undergoing CABG. The indications and correct time for surgery, as well as perioperative management should be emphasized.