乳内动脉在冠状动脉旁路移植术中的应用

Use of the internal mammary artery for coronary artery bypass

为了探索国人应用乳内动脉做冠状动脉旁路移植术的近期临床效果,从94年10月至98年3月共60例冠心病人采用乳内动脉、桡动脉及大隐静脉做冠状动脉旁路移植术(CABG).大多数为三支病变及左主干病变.中低温及常温体外循环,经主动脉根部间断灌注冷血或温血停跳液心肌保护.强调在取乳内动脉时要格外小心,不要用器械钳夹乳内动脉,牵拉应轻柔.采用8-0 Prolene线做乳内动脉与前降支等做远端吻合.吻合完成后应将乳内蒂固定于心脏表面,减少吻合口张力.最后切开左上心包让乳内动脉走行平坦,无张力.平均搭桥支数为3.5根.术后死亡1例,死亡率1.7%.使用乳内动脉做CABC是安全有效的.59例病人心绞痛完全缓解,活动能力及生活质量明显提高.

In order to studying the early clinical efficiency of coronary artery grafting with left internal mammary artery (IMA), 60 patient underwent coronary artery bypass grafting from Dec. 1994 to Mar. 1998. Most of them had extensive triple - vessel disease of left main coronary artery disease.The myocardium were protected by the intermittent antigrate cold or warm blood cardio-plegia.The IMA pedicle was mobilized carefully and must not be grasped with instruments, but only gently retracted.The technique of IMA anastomosis utilizes one 8 - 0 polypropylene suture placed as continuous stitch. After the anastomosis is completed, the important step of tacking the pedicel to the cardiac surface with a few interrupted sutures is performed to prevent any tension on the suture line. Finally the pericardium is cut down transversely on the left side to allow the pedicel to pass smoothly to the coronary artery. The mean graft was 3.5 vessels. The mortality was 1.7%. The IMA could be used safely and efficently. The efficacy of coronary artery bypass grafting are relieving angina pectoris, improving cardiac function and enhancing the quality of life.