不停跳冠状动脉旁路移植术的围术期处理

Peri-operative management of off-pump coronary artery bypass grafting.

目的总结我院行不停跳冠状动脉旁路移植术（OPCAB）患者围术期的处理经验。方法2007年1月至2008年5月，我院行OPCAB253例。左主干病变76例（18例为单纯左主干病变，其余58例同时合并其他分支病变），单支病变13例，2支病变32例，3支病变190例。急诊施行OPCAB18例。手术均经胸骨正中切口，采用冠状动脉固定器、分流栓完成血管吻合。结果术后死亡3例（1．2％）。有11例患者接受主动脉内球囊反搏治疗。术后机械通气时间3～168h，平均（24．1±22．3）h。ICU停留时间1—14d，平均（2．8±2．0）d。术后住院8～42d，平均（15．6±6．3）d。结论OPCAB适用于绝大多数单纯搭桥病例，经过恰当有效的围术期管理，能够收到满意的疗效。

Objective To retrospectively analyse the clinical data of off-pump coronary artery bypass grafting surgery（OPCAB） in our department and summarize the clinical experience of peri-operative management. Methods From January 2007 to May 2008,253 patients underwent OPCAB. Seventy-six cases with left main disease （ including 18 cases of single left main lesion and 58 cases of complex lesion） ; 13 cases had single vessel disease; 32 cases had double vessels disease and 190 cases had triple vessels disease. Eighteen cases received emergency OPCAB. All vessel anastomosis were performed with coronary artery stablizer and shunt through median sternotomy. Resuits Three cases died after operation （ 1.2% ）. Intra-aortic balloon pump was used in 11 cases. Mechanical ventilation time was 3-168 h [ （24.1 ± 22.3 ） h ], and ICU stay time was 1-14 day[ （2.8 ± 2. 0）d ]. Postoperative hospital stay time was 8-42 days[ （15.6 ±6.3）d]. Conclusion OPCAB is reliable for most bypass cases. With appropriate peri-operative management, a satisfied result will be acceptable.