跳动下冠状动脉搭桥术的手术方针及成绩

Strategies and results for off-pump CABG

目的 比较跳动下冠脉搭桥术（OPCAB）的术式选择对冠心病患者的影响,讨论移植血管的选择及围手术期管理方法 .方法 以我院心脏血管外科从2003年1月至2009年12月所实施的514例冠状动脉搭桥术（CABG）患者作为研究对象,其中体外循环下冠脉搭桥术（C-CABG）32例,OPCAB 482例.结果 术前合并脑血管障碍43例（8.4%）,合并透析16例（3.1%）,合并慢性闭塞性肺病（COPD）17例（3.3%）,既往有经皮冠状动脉成形术（PCI）35例（6.8%）,左主干（LMT）病变179例（34.8%）.平均远端吻合口数（3.6±1.4）个,移植血管全动脉化患者77例（14.9%）,使用左乳内动脉（LITA）患者421例（81.9%）.平均大隐静脉（SVG）使用支数为（1.6±0.5）支/例.术后主要合并症为脑血管病6例（1.1%）,纵隔感染4例（0.7%）,肾功能损害透析（CHDF）7例（1.3%）,房颤（Paf）46例（8.9%）.结论 对于高风险、高难度的CABG应用标准OPCAB术式,采用全动脉化及动、静脉移植血管相组合等低侵袭性手术方法 ,同时做好围手术期管理,可以提高CABG的远期手术成绩.

Objective To compare the effects on patients with coronary artery disease by different operative procedure of off-pump coronary artery bypass grafting （OPCAB）, discuss the selection of different grafts and perioperative management. Methods 514 eases received coronary artery bypass grafting （CABG） at China-Japan Friendship Hospital from January 2003 to December 2009, CABG were performed under eardiopulmonay bypass on 32 cases, OPCAB were performed on 482 cases. Results Preoperative coexisted diseases were cerebral vascular disease in 43 cases（ 8.4% ） , renal failure need dialysis in 16 cases（3.1%）,chronic obstructive pulmonary disease in 17 cases（3.3% ）, 35 cases（6.8% ） had history of percutaneous coronary implantation （PCI）, left main trunk discases were found in 179 cases（34.8%）. The average number of distal anastomosis site was （3.6±1.4）, total arterial grafts were used in 77（14.9% ）,left internal thoracic artery （LITA）was used in 421 cases（81.9%）. The average usage number of saphenous vein grafts （SVG） was （1.6±0.5）/case. The main postoperative complication included cerebral vascular disease in 6 eases（ 1.1% ）, mediastinal infection in 4 cases（0.7% ）, renal failure need dialysis in 7 cases （1.3%）,atrial fibrillation 46 eases （8.9%）. Conclusion Standard OPCAB should be performed on high risk and high challenge patients, low invasive operative methods such as total arterial grafts and composite arterial and veinous grafts should be applied. Careful perioperative management can improve long term surgical outcomes.