弥漫性冠状动脉病变心肌血运重建的外科治疗

Myocardial revascularization of patients with diffuse coronary artery disease

目的 回顾性分析弥漫性冠状动脉病变患者在非体外循环下行冠状动脉内膜剥脱加搭桥术重建心肌血运的治疗方法和经验,探讨其安全性与有效性.方法 2003年10月至2008年12月,在非体外循环下,对177例弥漫性冠状动脉病变患者、共229支病变血管于冠状动脉最硬处远端且距离剥脱远端≥2 cm处行切口,进行内膜剥脱,再用乳内动脉或大隐静脉行旁路血管移植术.结果 术中桥血流测定显示215支血管血流满意（93.9%）,桥血流量（27±12）ml/min;14支欠满意,桥血流量（7±4）ml/min.术后6例发生围手术期心肌梗死（3.4%）,其中3例无明显心脏血流动力学改变,3例发生低心排血量综合征,经主动脉内球囊反搏辅助治疗后好转出院.98例在术后3～40个月复查冠状动脉造影,显示桥血管均通畅.结论 非体外循环下冠状动脉内膜剥脱后再行搭桥术,对于弥漫性冠状动脉病变心肌血运重建是一种安全、有效的治疗方法.

Objective Off-pump coronary artery bypass grafting （off-pump CABG） after off-pump coronary endarterectomy （CE） for myocardial revascularization is a way to rescue the patients with diffuse coronary artery disease （CAD）. This study retrospectively analyzed its clinical outcomes and experiences,and explored the safety and effectiveness. Methods From October 2003 to December 2008, 177 diffuse CAD patients with 229 vascular lesions received off-pump CABG plus CE. Incision was made at the hardest part of coronary artery and≥ 2cm from the distal intervention site. Then bypass graft was performed by internal mammary artery or saphenous vein. Results The intra-operative blood tests showed that 215 （93. 9% ） bridges were satisfied with （27 ± 12） ml/min blood flow while 14 bridges were dissatisfied. The blood flow was （7 ± 4 ） inl/min. Six （3. 4% ） cases suffered peri-operative myocardial infarction. Among them, 3 patients had no significant cardiac homodynamic changes. Three suffered a low cardiac output and improved by intra-aortic balloon counter pulsation support. And they were then discharged after treatment After 3-40 months, 98 patients underwent coronary angiography to measure the graft latency. And the blood flow was excellent Conclusions Off-pump CABG plus CE for diffuse coronary artery disease is both feasible and safe. And it is an effective treatment with a high degree of vascularization.