体外循环下心脏不停跳搭桥在严重左心功能低下患者中的应用

On-Pump Beating Heart CABG in Patients with Severe Left Ventricular Dysfunction

目的对28例严重左心功能低下患者在体外循环下行心脏不停跳搭桥（on-pump beating heart,OPBH）的应用情况进行分析总结。方法2003年至2006年对28例择期需行冠状动脉旁路移植术（CABG）的严重左心功能低下患者施行OPBH下CABG术,其中早期左心功能低下行非体外循环搭桥（OPCAB）因血流动力学不能维持紧急转流OPBH6例,占同期OPCAB的6/702例（0.85%）,22例常规行OPBH下CABG术,分析总结OPBH在严重左心功能低下患者中的应用情况及体外循环管理经验。结果22例常规OPBH心脏搭桥（3.4±0.8）支,体外循环（extracorporeal circulation,ECC）时间（97.2±32.8）min,无严重并发症发生,随访2~24个月,心绞痛症状消失,心功能明显改善;紧急转流6例,搭桥（2.8±0.4）支,ECC时间（186.0±94.9）min,术中放置主动脉内球囊反搏（IABP）3例,围手术期死亡3例,分别于术后1 d、23 d、30 d死于心功能衰竭、多器官功能衰竭及急性肺栓塞。结论对严重左心功能低下无相对ECC禁忌患者采用OPBH是一种安全可靠的手术方法,有ECC相对禁忌患者除采用基本外科技术外,宜采用“湿备”。

OBJECTIVE To analyze the performances of the on-pump beating heart（OPBH） coronary artery bypass graft（CABG） in 28 patients with severe left ventricular dysfunction.METHODS From 2003 to 2006,28 cases having left ventricular dysfunction undertook selective CABG with OPBH.There were 6 cases of emergent switching to extracorporeal circulation（ECC） due to unstable hemodynamic,which was 0.85% in the same period of OPCAB cases（6/702）,and 22 selected cases undertook routine OPBH CABG.The procedure and the experience of the OPBH were analyzed.RESULTS In the 22 routine OPBH CABG cases, the number of grafts was（3.4±0.8）,the time of ECC was（97.2±32.8） min,and no severe complications happened.The number of the grafts was（2.8±0.4）,and the time of ECC was（186.0±94.9） min in the group of emergent switch,meanwhile, intra-aortic balloon pump was used in 3 cases during opertion and 3 cases died of heart failure,multi-organ failure and acute pulmonary thromboembolism after operation.CONCLUSION The reasonable application of OPBH CABG is safe and credible for patients with severe left ventricular dysfunction.