冠状动脉旁路移植术治疗重症冠心病25例临床分析

Clinical analysis of coronary artery bypass grafting for severe coronary artery disease in 25 cases

目的总结本科1999年6月～2006年12月行重症冠心病患者施行CABG 25例临床经验。方法25例患者中合并陈旧性心肌梗死6例，急性心肌梗死5例，合并二尖瓣和／或主动脉瓣病变5例，心肌梗死后巨大室壁瘤2例，左室功能重度减退（EF〈30％）6例。20例在中低温体外循环（CPB）下进行CABG手术，同时行瓣膜置换术5例。5例在非CPB下进行搭桥。结果本组术后早期死亡3例，其中围手术期心肌梗死2例，胸骨哆开后呼吸功能衰竭1例。另并发肺部感染4例，经积极抗感染，加强营养支持后好转。术后静脉桥分支出血心包填塞1例，二次手术止血后好转。结论要提高重症患者的CABG手术的成功率，必须重视术前合并症的处理，术中加强心肌的保护，无合并其他心内手术者，尽可能行OPCABG，要选择适宜的血管移植材料，重视吻合技巧的训练。

Objective In order to improve the results of coronary artery bypass grafting（CABG） for patients with severe coronary artery disease. Methods A retrospective study was carried out to review experience. A total of 25 cases with severe coronary artery disease underwent CABG beteen Jun 1999 to Dec 2006 were analyzed,5 cases with mitral or aortic valve dysfounction were replaced,2 cases with vntricular aneurysm were resected,CABG with cardiopulmonary bypass（CPB） was performed in 20 patients, off-pump CABG was performed in 5 patients. The numbers of internal mammary arterial grafts and saphenous vein grafts was 18 and 52. The mean number of grafts were 2.8. Results There were 3 patients postoperative death due to myocardial infarction and pneumonia. The others recovered smoothly, angina pectoris were totally relieved or alleviated observably. Follow up varied from 8 to 78 months,the results are rather satisfactory. Conclusion Coronary artery bypass grafting is a safe and effective method for patients with severe coronary artery disease. The key of successful operation are the choice of the patients, the proper management during perioperative period,satisfactory myocardial protection and accurately anastomsis.