再次冠状动脉旁路移植术312例临床分析

Repeated Coronary Artery Bypass Grafting in 312 Patients

目的研究再次冠脉搭桥术（CABG）的影响因素及手术效果。方法1992～1996年Hartford医院所作的CABG312例资料进行分析。结果病人平均年龄65±9岁。距上次手术的时间为11．8±4．5年。共搭桥1069根，其中动脉桥386根，包括胸廓内动脉、桡动脉和胃网膜右动脉，静脉桥682根，Gore－Tex桥1根。死亡14例（4．5％），围术期心肌梗塞15例（4．8％），术后低心排46例。有131例病人术前、术中或术后应用主动脉内气囊反搏装置（IABP），其中119例心功能恢复而脱离IABP。结论再次CABG难度、风险均增大，但仍可获得相当满意的手术效果。

Objective To study repeated coronary artery bypass grafting (CABG).Methods Three hundred and twelve cases of CABG which were performed in Hartford Hospital between 1992 to 1996 were analyzed. Results The mean age were 65i9 years old. The average time from the first CABG were 11.8±4.5 year. A total of 1069 grafts were used:386 were arterial including internal thoracic mammary artery, radial artery and gastroepiploic artery; 682 were venous and 1 was Gore-Tex. The operative mortality was 4.5%. Fifteen had preoperative myocardial infarction(4.8%), and 45 had low cardiac outputsyndrome after operation. IABP was used in 131 patients before, during or after operation.Among them 119 were weaned from IABP. Conclusion Although the difficulty and riskfactors were increased, the results of redo CABG was still good in our series.