摘要
目的比较分析主动和被动改转体外循环下冠状动脉旁路移植术早期效果,探讨非体外循环下冠状动脉旁路移植术(OPCABG)中改转的原因和临床处理措施。方法选择北京安贞医院因各种原因被迫放弃OPCABG改转为常规体外循环下冠状动脉旁路移植术(ON-PUMP CABG)患者23例(OPCABG组),同时选择ON-PUMP CABG病例23例(ON-PUMP CABG组)作为对照。2组年龄、性别、高血压史、糖尿病史、心肌梗死史、心功能、左心室射血分数和舒张末期容积、冠状动脉病变支数及搭桥支数基本配对,对其手术时间、术中输血量、ICU监护时间、主动脉内球囊反搏(IABP)治疗及围术期死亡率进行比较。结果与ON-PUMP CABG组比较,OPCABG组术中低血压、心室纤颤明显增高,手术时间、ICU监护时间明显延长,术中输血量、IABP使用人数也明显增多(均P<0.05)。OPCABG组术中改转的原因:持续性低血压11例,心室纤颤6例,低血压并心室纤颤4例,为追求完全血管化2例。改转组围术期死亡人数高于体外循环组(4:2),但差异无统计学意义(P>0.05)。结论与主动体外循环相比,被动改转体外循环患者手术风险和医疗费用明显增加,改转的主要原因是术中为充分暴露靶血管搬动心脏导致的低血压和(或)心室纤颤,因此在左心室扩大和心功能差的患者进行OPCABG时,如何维持血液动力学稳定和处理恶性心率失常对于术者和麻醉医师非常重要,也许主动采用体外循环更为安全,尤其在刚开展或经验较少的基层医院。
Objective To compare the early surgical outcomes for aborted off-pump versus onpump coronary artery bypass grafting patients and discuss the convert reasons and their clinical management.Methods Selected from the completed off-pump coronary artery bypass （OPCABG）,in Anzhen hospital,whereas 23 were converted to on-pump （OPCABG group）.At the mean time,23 patients underwent ON-PUMP CABG initially were selected as control（ON-PUMP CABG group） with matched preoperative risk factors,include the surgeons,age,gender,histories of hypertension,diabetes and priomyocardiac infarction,heart function,ejective fraction and diastolic volume of left ventricle,diseased vessels and grafts.All patients were investigated casebycase in surgical time,transfusion during surgery,ICU stay time,intraaortic balloon pump （IABP） therapy,the convert reasons and preoperative mortality.Results Compared with the ON-PUMP CABG,the number of convert patients who showed low blood pressure and ventricular fibrillation was obviously higher,the surgical time significantly prolonged,the blood transfused during surgery increased,intensive care and the number of IABP use increased（all P0.05）.There were no significant differences in preoperative mortality（P0.05）.The main reasons for conversion from off-pump to ON-PUMP CABG were low blood pressure（11）,ventricular fibrillation （6）,lowblood pressure and ventricular fibrillation（4）,and wanted to be ABSolutely perficition（2）.Conclusion Patients who are intended for an off-pump strategy and then require conversion to on-pump meet significantly increased surgical risks and cost compared with that of conventional ON-PUMP CABG.The main reasons for conversion are low blood pressure and ventricular fibrillation caused by displacement of heart to expose the target vessels.Therefore how to maintaining hemodynamic stability and manage the malignant arrhythmia for those patients with LV hypertrophy and depressed heart function during OPCABG are great challenges to surgeons and anesthetists.Face on such high risks patients,ON-PUMP CABG may be a better operative strategy rather than OPCABG,especially in the unit without abundant experience of CABG.
出处
《江西医学院学报》
2009年第9期28-31,共4页
Acta Academiae Medicinae Jiangxi
