1386例不停跳冠状动脉旁路移植术经验总结

Clinical analysis of 1386 patients undergoing off-pump coronary artery bypass grafting.

目的总结2002年1月至2008年3月全国多中心1386例冠心病患者实施不停跳冠状动脉搭桥术的经验。方法常温下全身麻醉气管插管，胸骨正中切口，取左侧乳内动脉、桡动脉及大隐静脉，行不停跳冠状动脉旁路术。70岁以上患者占32．35％，年龄最大为99岁，急诊或亚急诊手术111例，二次冠状动脉旁路术52例。结果围术期死亡24例，总病死率1．73％，其余患者均痊愈出院，术后心绞痛症状明显缓解，生活质量较术前明显提高。结论不停跳冠状动脉旁路移植术对高龄及合并其他慢性老年疾病患者是可行的，熟练的手术技术，对手术适应证的把握，积极的围术期处理是手术成功的关键。

Objective To summarize the clinical experiences of 1386 patients undergoing off-pump coronary artery bypass grafting（OPCAB） during Jan 2002 to Mar 2008. Methods OPCAB was done through midsternumtomy under ordinary-temperature anesthesia after radial artery, left breast artery and vena saphena magna were taken. Patients over 70 years old accounted for 32.35%, and the oldest was 99 years old. Emergency and subemergency OPCAB was done in 111 cases, re-do CABG with off-pump technique was done in 52 patients. Results 24 cases died during perioperation,with mortality of 1.73% and all other patients discharged from the hospital. Following operation, the symptoms of angina pectoris were relieved and the life quality was much better than that before operation. Conclusion OPCAB is feasible for older patients, who are complicated with other chronic diseases for elder patients. Skillful technique of surgeon ,right indications for OPCAB and management of peri- and postoperation are key to success of operation.