高龄患者冠状动脉旁路移植术体外循环中的心肌保护

Myocardial Protection of Aged Patients during On-Pump Coronary Artery Bypass Grafting

目的观察高龄(≥70岁)冠心病患者冠状动脉旁路移植术(CABG)中的心肌保护的临床效果。方法总结我院近1年高龄(≥70岁)冠心病患者体外循环下行CABG 20例,包括介入治疗术后3例(心内支架术后急诊搭桥1例),体外循环中运用冷血停搏液顺灌-冷血持续逆灌-开升主动脉前温血顺灌的心肌保护方法。结果全组20例患者心脏自动复跳16例,占80%;电击复律4例,占20%。术后胸骨感染1例,围术期死亡1例,其余患者均痊愈出院。结论高龄(≥70岁)患者体外循环下行CABG,体外循环中运用冷血停搏液顺灌-冷血持续逆灌-开升主动脉前温血顺灌为有效的心肌保护方法,自动复跳率高。

OBJECTIVE To observe the clinical effect of myocardial protection on aged patients （ ≥70 years）during coronary artery bypass grafting（CABG）. METHODS To review the methods of myocardial protection of 20 aged patients （ ≥ 70 years） during on - pump CABG in my hospital from 2007 -06 to 2008 -06. Myocardial preservation of antegrade perfusion with cold -blooded cardioplegic solution, continuous retrograde perfusion with cold- blood and antegrade petfusion with warming blood before releasing the aortic cross - clamp, was used in extracorporeal circulation. RESULTS Automatic heart beat recovery rate was 80% （ 16/20 patients） ,4 patients need to be defibrillated. One patient occurred sternum infection postoperatively, one died of cardiac failure after operation, the others recovered. CONCLUSION To aged patients （ ≥70 years） underwent on -pump CABG, the way of antegrade perfusion with cold -blooded cardioplegic solution, continuous retrograde perfusion with cold - blood and antegrade perfusion with warming blood before releasing the aortic cross - clamp, is an effective myocardial protective method with high rate of automatical heart beat recovery.