非体外循环下冠脉搭桥术32例临床分析

Clinical analysis of off-pump coronary artery bypass grafting on beating heart

目的总结非体外循环下冠脉搭桥术（off-pump coronary artery bypass grafting，OPCABG）的临床经验，评价其疗效和安全性。方法我院自2007年10月-2009年5月有32例冠心痛患者采用OPCABG。手术经胸骨正中切口入胸，使用内乳动脉及大隐静脉，利用胸骨牵开器和心脏表面固定器、冠状动脉分流栓等行OPCABG。结果手术全部成功，全组无死亡病例。共搭桥90支，平均每例2．8支（1～4支），动脉桥31支，静脉桥59支。手术时间72～195min，平均（125．3士57．4）min。术后24h引流量100～1200ml，平均（257．6士86．2）ml。输血或者使用血制品0～1600ml，平均（292．8±76．9）ml，其中10例患者未输人库血。无围术期心肌梗死、低心排及神经系统并发症。术后ICU入住时间（2．5±1．7）d，呼吸机辅助时间（18．4±10．5）h。术后平均住院（9．3±3．8）d，全部患者出院时心绞痛症状消失。术后随访1～12个月均无症状，生活质量提高。结论OPCABG具有微创、安全、经济、有效等特点，适宜单、多支冠状动脉病变及高龄、心功能不全、合并其他重要脏器功能不全或对体外循环风险较大者。

Objective To summarize the clinical experience and evaluate the efficacy and safety of off-pump coronary artery bypass grafting （OPCABG） on the beating heart. Methods 32 patients underwent OPCABG with internal mammary artery and great saphenous vein in the median incision of sternum. All the procedures were carried out with the assistance of sternum retractor, heart stabilizer and coronary artery shunt. Result All operation achieved successful operation. There was no perioperative death. 90 branches （mean 2.8±1.2） of continues suture bypass grafting were made including 31 branches of left internal mammary artery and 59 branches of great saphenous vein. The operation time was 125.3±57.4 minutes. 24 hours postoperative bleeding volume was 257.6±86.2 ml. Transfution was 292.8±76.9 ml. 10 patients were not given transfution. No perioperative myocardial infarction, low cardiac output and neurological com- plications happened. ICU stay was 2. 5± 1.7 days, and mechanical ventilation time was 18. 4±10.5 hours. Hospital stay was 9.3±3.8 days. Angina in all cases disappeared when they discharged from hospital. No patient showed postoperative angina and the quality of life was improved during 1 to 12 months following-up. Conclusions With the characteristics of minimally invasion, safety, economy and effect, OPCABG was suitable for patients with single or multi-vessel coronary artery disease, old age, cardiac dysfunction, incorporating other major organ dysfunction or high risk to cardiopulmonary bypass.