冠状动脉旁路移植术临床应用45例

Clinical Application of Coronary Artery Bypass Grafting performed on 45 patients

目的：探讨冠状动脉旁路移植术（CABG）治疗冠心病的临床疗效。方法：采用CABG手术治疗冠心病患者45例，其中冠脉3支及以上病变35例，2支病变6例，1支病变4例。常规体外循环下手术（cCABG）30例，非体外循环下手术（OPCAB）15例。共行远端吻合口139个，其中动脉旁路远端吻合口36个，静脉旁路远端吻合口103个，包括心中静脉原位动脉化吻合口1个。结果：完成手术44例（97．78％），术中死亡1例（2．22％）。术后并发低心排血综合征、严重心律失常各1例，肺部及胸骨感染各2例，均治愈出院。随访2～84个月，平均（32±7．6）月。1例术后高血糖酸中毒6h突发室颤，植物生存6个月后死亡，另1例术后6年脑血管意外死亡。术后1年心绞痛复发2例，服药控制；其余40例心绞痛消失。结论：应用cCABG和OPCAB手术方法治疗冠心病患者是安全、可靠的技术，效果良好。OPCAB手术虽具有一定的优势，但仍不能完全替代cCABG手术。

Objective ：To evaluate clinical effect of coronary artery bypass grafting （CABG） in the treatment of coronary artery disease （CAD）. Methods ：45 patients with CAD received CABG. The triple, double and single vessel diseases were noted in 35,6 and 4 cases, respectively. Thirty patients underwent coronary artery revascularization with conventional cardiopulmonary bypass （cCABG） , 15 off-pump coronary artery bypass grafting. （OPCAB）. A total of 139 anastomosis sites were done, among which, 36 were left internal mammary artery, 103 were greater saphenous veins including terminal end-to-side 1 arterialization graft by Saphenous vein and middle cardiac vein with right coronary venous anastomosis. Results：44 cases went through the operation successfully（97.78% ）. One patients died in the process of operation, the mortality of 2.22%. The postoperative low cardiac output syndrome and severe arrhythmia respectively occurred to one case. The pulmonary and sternum infection appeared in 2 cases, respectively. During follow-up period of 2 to 84 months, an average of （32 ± 7.6） months, one patient appeared postoperative hyperglycosemia acidosis and accidental ventricular fibrillation, became a plant man, and survived for 6 months. Another patient died of cerebral vascular disease 6 years after operation. The others were free from angina except for two cases recurred angina one year after operation, which could be controlled by medicine. Conclusions：Applicatlon of cCABG and OPCAB technigues in the treatment of coronary heart disease was safe and practicable. OPCAB showed some advantages if the chosen indications and methods were correct, but it couldn＇t replace cCABG.