45岁以下冠状动脉搭桥患者71例临床观察

Clinical observation of off-pump coronary artery bypass grafting in 71 patients under 45 years of age

目的:冠状动脉旁路手术已成为冠心病患者的有效治疗手段之一,青年冠心病患者逐年增多,分析我科10余年来45岁以下冠状动脉搭桥患者的临床特点。方法:连续71例45岁以下冠心病患者,在非体外循环下行冠状动脉搭桥术(Off-pump coronary artery bypass grafting,OPCAB)。对于术前确诊无左心室附壁血栓的室壁瘤患者,在OPCAB同时行左心室室壁瘤缝缩术。对于冠状动脉存在弥散性病变的患者,采用冠状动脉内膜剥脱术式。而对右冠状动脉存在弥散性病变且管径细小的患者,施行选择性冠状静脉动脉化。并对患者例数变化、旁路血管移植支数、同期采用术式、愈后、并发症发生情况及OPCAB移植血管应用情况等指标进行总结。结果:患者平均移植旁路血管(3.0±0.7)支。术后死亡2例(2.8%)。29例施行全动脉化搭桥。同期行左心室室壁瘤折叠缝缩术7例。冠状动脉内膜剥脱术1例。1996年10月至2008年12月接受OPCAB手术的患者数量与比例逐年上升,但从2006年开始,45岁以下冠心病患者接受OPCAB手术呈逐年减少趋势,与其他年龄组患者相比,双乳内动脉搭桥比例高(P<0.05)。而搭桥数目差异无统计学意义(P>0.05)。结论:青年冠状动脉搭桥患者男性比例高,冠状动脉病变弥散,双乳内动脉搭桥比例高。对于远端血管纤细的患者,可以采用选择性冠状静脉动脉化手术,近期效果满意。

Objective：Coronary artery bypass graft has been one of the effective treatment tools for patients with coronary artery disease. Young patients increase year by year. Then we’ll analyze and summary clinical presentations of patients underwent off-pump coronary artery bypass grafting who are all younger than 45 years old. Methods：71 consecutive patients underwent OPCAB in this study. For preoperative diagnosis of leftventricular mural thrombus without aneurysm patients,we performed plication of left ventricular aneurysm duringoff-pump coronary artery bypass surgery; for patients with diffused coronary artery disease,coronary endarterecto-my; for patients with diffused and small diemeter of the right coronary artery,selective coronary venous arterial-ization. The following perioperative variables were reviewed and evaluated： the changing in the number of pa-tients,different grafting strategies,the grafts per patient,postoperative complications and clinical outcomes. Results：The mean grafts per patient were （3. 0 ±0. 7）. The total hospital mortality was 2. 8% （2 of 71 patients）.Among them,29 patients underwent total arterial bypass. Over the same period,7 patients underwent plication ofleft ventricular aneurysm. Coronary artery endarterectomy in 1 patient. From October 1996 to December 2008,The population with OPCAB increased year by year,but the number of patients younger than 45 years old who underwent OPCAB decreased year by year from 2006. The percentage of bilateral internal mammary artery usage ishigher in this group than the patients older than 45 years of age（P 0. 05）. Meanwhile,there was no statisticsignificance ofdifference in total grafts（P 0. 05）. Conclusion：For young,the proportion of male was higher,and coronary artery lesions were diffuse. For patients with long segment diffuse distal lesions,coronary venous by-pass graft can be considered to use,and the early-term curative effects are satisfied.